Work

Sources of practice variation in febrile infants aged 8–60 days: a multi-level analysis

Year: 2026

Type: article

Abstract: BACKGROUND: Management decisions for febrile infants vary greatly, with knowledge gaps in identifying sources of practice variation. Thus, we estimated proportions of total and age-stratified (8-28, 29-60 days) variation in hospitalization and lumbar puncture procedures contributed by patient (infant)-, physician-, and hospital-level factors. METHODS: Retrospective cohort study of febrile infants aged 8-60 days seen in emergency departments in New York State from January 2012 to July 2021. We constructed a three-level multi-level logistic regression model with random effects for physician and hospital levels to partition total and age-stratified variation in hospitalizations and lumbar puncture procedures and adjusted for covariates at each level. RESULTS: Of 35,756 febrile infants,18,124 were hospitalized (49%) and 12,959 received a lumbar puncture (36%). Adjusted models showed physician- and infant-level factors contributed the most to variation in hospitalization (59.3%) and lumbar puncture management decisions (81.9%), respectively. Hospital-level factors accounted for >10% of variation in hospitalizations and ~10% of variation in lumbar punctures. Hospital-level variation did not differ significantly by age. CONCLUSIONS: Findings show divergent practice variation sources for hospitalization (physician-level) and lumbar puncture (infant-level). Hospital-level factors account for a non-negligible proportion of practice variation, representing opportunities to identify targeted interventions to reduce practice variation. IMPACT: Management decisions for febrile infants aged 8 to 60 days vary greatly Little is known about sources of practice variation that may be modifiable In this population-based cohort study, physician- and infant-level factors contributed the most to variation in hospitalization and lumbar puncture Hospital-level factors accounted for at least 10% of variation in hospitalizations and lumbar punctures Findings inform future hospital-level intervention studies.

Source: Pediatric Research

DOI: 10.1038/s41390-026-05603-2

Authors: Jeffrey P. Yaeger, Sudhir Singh, Tanzy Love, Kevin A. Fiscella

Institutions: University of Rochester Medicine, University of Rochester

Language: English

Topic: Healthcare cost, quality, practices

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,390