Health information exchange reduces repeated diagnostic imaging for back pain.

STUDY OBJECTIVE: This study seeks to determine whether health information exchange reduces repeated diagnostic imaging and related costs in emergency back pain evaluation. METHODS: This was a longitudinal data analysis of health information exchange patient-visit data. All repeated emergency department (ED) patient visits for back pain with previous ED diagnostic imaging to a Memphis metropolitan area ED between August 1, 2007, and July 31, 2009, were included. Use of a regional health information exchange by ED personnel to access the patient's record during the emergency visit was the primary independent variable. Main outcomes included repeated lumbar or thoracic diagnostic imaging (radiograph, computed tomography [CT], or magnetic resonance imaging [MRI]) and total patient-visit estimated cost. RESULTS: One hundred seventy-nine (22.4%) of the 800 qualifying repeated back pain visits resulted in repeated diagnostic imaging (radiograph 84.9%, CT 6.1%, and MRI 9.5%). Health information exchange use in the study population was low, at 12.5%, and health care providers as opposed to administrative/nursing staff accounted for 80% of the total health information exchange use. Health information exchange use by any ED personnel was associated with reduced repeated diagnostic imaging (odds ratio 0.36; 95% confidence interval 0.18 to 0.71), as was physician or nurse practitioner health information exchange use (odds ratio 0.47; 95% confidence interval 0.23 to 0.96). No cost savings were associated with health information exchange use because of increased CT imaging when health care providers used health information exchange. CONCLUSION: Health information exchange use is associated with 64% lower odds of repeated diagnostic imaging in the emergency evaluation of back pain. Health information exchange effect on estimated costs was negligible. More studies are needed to evaluate specific strategies to increase health information exchange use and further decrease potentially unnecessary diagnostic imaging and associated costs of care.

The lived experience of nurse practitioners practicing within the Transformational Advanced Professional Practice Model: A phenomenological study.

PURPOSE: The purpose of this study was to describe the lived experiences of nurse practitioners (NPs) practicing within the Transformational Advanced Professional Practice (TAPP) Model, a professional practice model (PPM). DATA SOURCES: A descriptive phenomenological analysis using semistructured interviews of 11 NPs across multiple inpatient and outpatient clinical areas at Texas Children's Hospital. Member checking and theming data occurred using Colaizzi's Method concurrently with Mind Mapping technique. CONCLUSIONS: Main themes included: (a) transforming professional practice, (b) cultivating the inner self, and (c) mentoring professional transitions. IMPLICATIONS FOR PRACTICE: The findings of this study provide qualitative evidence that the TAPP Model influences role transition and professional development. Transforming NP practice within organizations and within the nursing profession itself will take mindfulness with an intentional approach to design PPMs specifically for NPs.

Development of the transformational advanced professional practice model.

PURPOSE: The purpose of this article is to describe the development of a professional practice model (PPM) for advanced practice registered nurses (APRNs). DATA SOURCES: A literature review was conducted on PPMs. Simultaneous review of authoritative resources, including The National Organization of Nurse Practitioner Faculties (NONPF) and the Licensure, Accreditation, Certification and Education (LACE) Consensus Model, was performed. An expert panel was established to validate the transformational advanced professional practice (TAPP) model. CONCLUSION: APRNs are relied upon by organizations to provide leadership in the delivery of high-quality, cost-effective health care while improving access and eliminating preventable morbidities. Existing models fail to fully capture the professional scope of practice for APRNs. The TAPP model serves as a framework to guide professional development and mentorship of APRNs in seven domains of professional practice (DOPP). IMPLICATIONS FOR PRACTICE: To meet the Institute of Medicine's recommendations for the future of nursing, APRNs should practice to the fullest extent of their education and training. Providing clarification regarding the DOPP of the APRN role is needed to standardized professional practice. The TAPP model is an inspiring blueprint that allows APRNs to model the way by delivering comprehensive health care in seven DOPP.

Are anomalous invasion speeds robust to demographic stochasticity?

Two important issues for conservation are the range expansion of species as a result of climate change and the invasion of exotic species. Being able to predict the rate at which species spread is key for successful management. In deterministic models, the invasion speed of a polymorphic population can be faster than that of any of the component phenotypes, and these "anomalous" invasion speeds persist even when the mutation rate between phenotypes is vanishingly small. Here we investigate whether the same phenomenon is observed in a model with demographic stochasticity. The model that we use is discrete in time and space and we carry out numerical simulations to determine the invasion speed of a population that has two morphs which differ in their dispersal abilities. We find that anomalous speeds are observed in the stochastic model, but only when the carrying capacity of the population is large or the mutation rate between morphs is high enough. These results suggest that only species with large population sizes, such as many insect species, may be able to invade faster if they are polymorphic than if there is only a single morph present in the population.

Dispersal polymorphism and the speed of biological invasions.

The speed at which biological range expansions occur has important consequences for the conservation management of species experiencing climate change and for invasion by exotic organisms. Rates of dispersal and population growth are known to affect the speed of invasion, but little is known about the effect of having a community of dispersal phenotypes on the rate of range expansion. We use reaction-diffusion equations to model the invasion of a species with two dispersal phenotypes into a previously unoccupied landscape. These phenotypes differ in both their dispersal rate and population growth rate. We find that the presence of both phenotypes can result in faster range expansions than if only a single phenotype were present in the landscape. For biologically realistic parameters, the invasion can occur up to twice as fast as a result of this polymorphism. This has implications for predicting the speed of biological invasions, suggesting that speeds cannot just be predicted from looking at a single phenotype and that the full community of phenotypes needs to be taken into consideration.