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					The role of ICT in supporting disruptiveinnovation: a multi-site qualitative study of
nursepractitioners in emergency departments
Abstract
Background:
The disruptive potential of the Nurse Practitioner (NP) is evident in their abilityto offer
services traditionally provided by primary care practitioners and their provision of ahealth
promotion model of care in response to changing health trends. No study hasqualitatively
investigated the role of the Emergency NP in Australia, nor the impact ofInformation and
Communication Technology (ICT) on this disruptive workforce innovation.This study aimed
to investigate ways in which Nurse Practitioners (NP) have incorporated theuse ofICT as a
mechanism to support their new clinical role within Emergency Departments.
Methods:
A cross-sectional qualitative study was undertaken in the Emergency Departments (EDs)
oftwo largeAustralian metropolitan public teaching hospitals. Semi-structured, in-
depthinterviews were conducted with fivenurse practitioners, four senior physicians and
fivesenior nurses. Transcribed interviews were analysed using agrounded theory approach
todevelop themes in relation to the conceptualisation of the ED nurse practitioner roleand
theinfluences of ICT upon the role. Member checking of results was achieved by revisiting
thesites to clarifyfindings with participants and further explore emergent themes.
Results:
The role of the ENP was distinguished from those of Emergency nurses and physicians bytwo
elements:advanced     practice   and    holistic   care,   respectively.   ICT    supported   the
advancedpractice dimension of the NP role intwo ways: availability and completeness of
electronicpatient information enhanced timeliness and quality ofdiagnostic and therapeutic
decisionmaking, expediting patient access to appropriate care. The ubiquity of patientdata
sourcedfrom a central database supported and improved quality of communication between
healthprofessionals within and across sites, with wider diffusion of the Electronic Medical
Recordholding the potential tofurther facilitate team-based, holistic care.
Conclusions:
ICT is afacilitator through which the disruptive impact of NPs can be extended. However,
integrationof ICT into work practices without detracting from provider-patient interaction is
crucial toensure utilisation ofsuch interventions and realisation of potential benefits.


                           Chronic rhinosinusitis, race, and ethnicity
Zachary M. Soler, M.D., M.Sc.,1 Jess C. Mace, M.P.H.,2 Jamie R. Litvack, M.D., M.S.,3and
Timothy L. Smith, M.D., M.P.H.2
ABSTRACT
Background:
Little is known regarding the epidemiology of chronic rhinosinusitis (CRS) in racial andethnic
minorities in the United States. This studywas designed to comprehensively evaluatethe
current prevalence of CRS across various treatment settings to identify possibledisparities in
health care accessand use between racial and ethnic populations.
Methods:
The National Health Interview Survey (NHIS), National Ambulatory Medical Care
Survey(NAMCS), and National Hospital AmbulatoryMedical Care Survey (NHAMCS)
databaseregistries were extracted to identify the national prevalence of CRS in race/ethnic
populationsand resource usein ambulatory care settings. Systematic literature review
identified studiesreporting treatment outcomes in minority patients electing endoscopic sinus
surgery(ESS).Data were supplemented using a multi-institutional cohort of patients
undergoing surgicaltreatment.
Results:
National survey data suggest CRS is a significant health condition for all major
race/ethnicgroups in the United States, accounting for a sizableportion of office, emergency,
andoutpatient visits. Differences in insurance status, work absenteeism, and resource use
werefound between race/ethnic groups.Despite its prevalence, few published studies
includeinformation regarding minority patients with CRS. Most (90%) cohort studies did not
providedetailsof race/ethnicity for ESS outcomes. Prospective cohort analysis indicated
thatminority surgical patients accounted for only 18%, when compared with nationalcensus
estimates (35%).
Conclusion:
CRS is an important health condition for all major race/ethnic groups in the United
States.Significant differences may exist across racial andethnic categories with regard to
CRShealth status and health care use. Given current demographic shifts in the United
States,specific attention should be givento understanding CRS within the context of racial
andethnic populations. Public clinical trial registration (www.clinicaltrials.gov) I.D.
No.NCT00799097.
                   (Am J Rhinol Allergy 26, 110–116, 2012; doi: 10.2500/ajra.2012.26.3741)
     Peran ICT dalam mendukung disruptiveinnovation: multi-situs kualitatif studi
                         nursepractitioners di bagian gawat darurat


Abstrak
Latar Belakang:
          Potensi mengganggu dari Nurse Practitioner (NP) jelas dalam tawaran mereka layanan
abilityto tradisional disediakan oleh praktisi perawatan primer dan penyediaan mereka model
promosi ahealth perawatan dalam menanggapi tren kesehatan berubah. Penelitian ada
hasqualitatively menyelidiki peran NP Darurat di Australia, maupun ofInformation dampak
dan Komunikasi Teknologi (ICT) pada studi innovation.This tenaga kerja mengganggu
bertujuan untuk menyelidiki cara-cara di mana Perawat Praktisi (NP) telah memasukkan
ofICT theuse sebagai mekanisme untuk mendukung peran baru klinis mereka dalam
Departemen Darurat.

Metode:
          Sebuah studi kualitatif cross-sectional dilakukan di Departemen Darurat (EDS) idua
largeAustralian metropolitan rumah sakit pendidikan publik. Semi-terstruktur, di-
depthinterviews dilakukan dengan praktisi fivenurse, empat dokter senior dan perawat
fivesenior. Wawancara ditranskripsi dianalisis dengan menggunakan pendekatan teori
agrounded todevelop tema dalam kaitannya dengan konseptualisasi dari theinfluences perawat
praktisi roleand ED ICT pada peran. Anggota pengecekan hasil dicapai dengan meninjau
kembali thesites untuk clarifyfindings dengan peserta dan lebih mengeksplorasi tema muncul.

Hasil:
          Peran ENP itu dibedakan dari orang perawat Darurat dan bytwo dokter elemen:
praktek     maju   dan   perawatan   holistik,   masing-masing.   TIK   mendukung dimensi
advancedpractice peran NP cara intwo: ketersediaan dan kelengkapan informasi ketepatan
waktu electronicpatient ditingkatkan dan ofdiagnostic kualitas dan pengambilan keputusan
terapi, mempercepat akses pasien untuk perawatan yang tepat. Mana-mana patientdata
sourcedfrom database pusat didukung dan ditingkatkan kualitas komunikasi antara
healthprofessionals dalam dan di situs, dengan difusi yang lebih luas dari Recordholding
Medis Elektronik tofurther potensial memfasilitasi berbasis tim, perawatan holistik.

Kesimpulan:
          TIK adalah afacilitator melalui mana dampak mengganggu NP dapat diperpanjang.
Namun, integrationof ICT ke dalam praktek kerja tanpa mengurangi provider-pasien interaksi
sangat penting toensure intervensi ofsuch pemanfaatan dan realisasi potensi manfaat.
Kronis rinosinusitis, ras, dan etnis Zachary M. Soler, MD, M.Sc., 1 Jess C. Mace, MPH,
             2 Jamie R. Litvack, MD, MS, 3and Timothy L. Smith, MD, MPH2


ABSTRAK
Latar Belakang:
         Sedikit yang diketahui mengenai epidemiologi rinosinusitis kronis (CRS) dalam
minoritas andethnic ras di Amerika Serikat. Ini studywas dirancang untuk secara
komprehensif evaluatethe prevalensi saat CRS di pengaturan berbagai perlakuan untuk
mengidentifikasi possibledisparities digunakan accessand kesehatan antara populasi ras dan
etnis.

Metode:
         Wawancara Survei Kesehatan Nasional (NHIS), National Ambulatory Medical Care
Survey (NAMCS), dan National Hospital Care Survey AmbulatoryMedical (NHAMCS)
databaseregistries diekstraksi untuk mengidentifikasi prevalensi nasional CRS dalam lomba /
sumber daya populationsand etnis usein pengaturan perawatan rawat jalan. Tinjauan literatur
sistematis diidentifikasi studiesreporting hasil pengobatan pada pasien minoritas memilih
bedah sinus endoskopi (ESS). Data yang dilengkapi dengan kohort multi-institusi pasien yang
menjalani surgicaltreatment.

Hasil:
         Data survei nasional menunjukkan CRS adalah suatu kondisi kesehatan yang
signifikan untuk semua ras utama / ethnicgroups di Amerika Serikat, akuntansi untuk
sizableportion kantor, darurat, kunjungan andoutpatient. Perbedaan status asuransi,
ketidakhadiran kerja, dan sumber daya werefound penggunaan antara ras / etnis
groups.Despite prevalensi, hanya sedikit studi yang diterbitkan includeinformation mengenai
pasien minoritas dengan CRS. Kebanyakan penelitian kohort (90%) tidak ras providedetailsof
/ etnis untuk hasil ESS. Analisis kohort prospektif menunjukkan thatminority pasien bedah
hanya menyumbang 18%, bila dibandingkan dengan perkiraan nationalcensus (35%).

Kesimpulan:
         CRS adalah kondisi kesehatan yang penting bagi semua ras utama / kelompok etnis
dalam perbedaan States.Significant Serikat mungkin ada di kategori andethnic rasial berkaitan
dengan statusnya CRShealth dan penggunaan perawatan kesehatan. Mengingat pergeseran
demografis saat ini di Amerika Serikat, perhatian khusus harus CRS pemahaman givento
dalam konteks populasi andethnic ras. Publik pendaftaran uji klinis

                    (Am J Rhinol Allergy 26, 110–116, 2012; doi: 10.2500/ajra.2012.26.3741)

				
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