Search

The purpose of this study was to examine differences between academic and behavioral outcomes for three cohorts of sixth grade boys enrolled at Starlight Middle School, a large, urban school in the Midwest. A comparison was made between pre-, partial, and full intervention data, during three consecutive years of implementation of School-wide Positive Behavior Supports (SWPBS) as a Tier 1, Response to Intervention (RTI) strategy. This study used an ex post facto design to examine relationships among variables in three cohorts of sixth grade boys. The dependent variables were office discipline referrals (ODRs), suspensions, and statewide standardized test scores from over 200 students in each cohort. The independent variables were ethnicity, special education, and socioeconomic status (SES). Quantitative data analysis revealed a significant reduction in the percentage of boys suspended and in the percentage of boys who received ODRs by Year 3, the year of full SWPBS implementation. During the study, state standardized test mean scores showed no statistically significant differences overall or within demographic groups. However, students who received ODRs or suspensions had statistically significant decreases in mean test scores, compared to boys with zero ODRs or suspensions. Boys who passed the ELA or mathematics portion of the state test had statistically significant lower mean rates of ODRs or suspensions, compared to boys who failed. SWPBS implementation resulted in statistically significant decreases in ODRs and suspensions for the general population of sixth grade boys, however students who were Black, receiving special education services, or low-SES status received disproportionate numbers of suspensions even in Year 3, as other research has found. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Background/Significance: Burns are dynamic, evolving wounds requiring prompt attention and treatment (Morgan et al., 2018). Many studies have been conducted comparing physician outcomes to those of APNs showing no difference (McCleery, Christensen, Peterson, Humphrey, & Helfand, 2011; Naylor & Kurtzman, 2010; Pioro et al., 2001; Roche, Gardner, & Jack, 2017; Spetz, Skillman, & Andrilla, 2017). Time delays which allow for progression of the injury have a negative impact on patient outcomes. Any pathway allowing for quicker review of the burn by a burn specialist should be welcomed (Kelly et al., 2013). APNs can augment physician efforts and expand access to care (Newhouse et al., 2011). Few research studies have been conducted in ambulatory settings where residents and APNs are directly compared. Studies which characterize the variability in the care provided in this population can better inform future staffing decisions. Purpose/Aims: To describe the difference in visit length, pain scores and per patient revenue between patients cared for in an overnight burn clinic by APNs compared to resident physicians. Aim 1: To describe the demographic (age, gender, ethnicity) and clinical variables (time in clinic, pain, provider type) of patients seen in the overnight burn clinic. Aim 2: To examine the relationships among demographics (age, gender, Ethnicity), provider type, pain, and time in clinic in patients cared for in an overnight burn clinic. Aim 3: To identify factors (demographic, pain, and provider data) that explain the variance in the time spent in the clinic. A secondary aim is to examine the difference in revenue generated by APNs. Setting: A regional burn center walk-in outpatient clinic at a southern California level 1 trauma center. Design: Retrospective descriptive comparative design. Cases: All patients who presented to the burn clinic between the hours of 6 pm and 6 am during the time period from October 1, 2015 to November 30, 2019. Methods: Data were retrieved from the burn registry and the hospital EHR. Descriptive statistics were utilized to address Aim 1. Tests of association were used address Aim 2. Multivariable linear regression was used to address Aim 3. A simple comparison of revenue generated, addressed the secondary aim. Results: Visit length was shorter for patients seen by nurse practitioners. There was no difference in opiate prescribing during the visit or at discharge. There was a dramatic increase in revenue during the first year. Conclusions: Burn care is dynamic and evolving. More timely treatment and pain relief in a non-biased environment by specially trained providers has incrementally improved care provided to these vulnerable patients.