What matters most in acute care: an interview study with older people living with frailty

Background Healthcare outcome goals are central to person-centred acute care, however evidence among older people is scarce. Older people who are living with frailty have distinct requirements for healthcare delivery and have distinct risk for adverse outcomes from healthcare. There is insufficient evidence for whether those living with frailty also have distinct healthcare outcome goals. This study explored the nature of acute care outcome goals in people living with frailty. Methods Healthcare outcome goals were explored using semi-structured patient interviews. Participants aged over 65 with Clinical Frailty Score 5-8 (mild to very severe frailty) were recruited during their first 72 hours in a UK hospital. Purposive, maximum variation sampling was guided by lay partners from a Patient and Public Involvement Forum specialising in ageing-related research. Qualitative analysis used a blended approach based on framework and constant comparative methodologies for the identification of themes. Findings were validated through triangulation with participant, lay partner, and technical expert review. Results The 22 participants were aged 71 to 98 and had mild to very severe frailty. One quarter were living with dementia. Most participants had reflected on their situation and considered their outcome goals. Theme categories (and corresponding sub-categories) were ‘Autonomy’ (information, control, and security) and ‘Functioning’ (physical, psychosocial, and relief). A novel ‘security’ theme was identified, whereby participants sought to feel safe in their usual living place and with their health problems. Those living with milder frailty were concerned to maintain ability to support loved ones, while those living with most severe frailty were concerned about burdening others. Conclusions Outcome goals for acute care among older participants living with frailty were influenced by the insecurity of their situation and fear of deterioration. Patients may be supported to feel safe and in control through appropriate information provision and functional support.

Designing locally-appropriate conservation incentives for small-scale fishers

Large, long-lived marine animals (‘marine megafauna’) play critical roles in ocean ecosystems, however, they are threatened by overfishing. Technologies and practices that reduce fisheries’ impacts on marine megafauna are well documented, yet less is known about how to encourage their adoption. This is particularly challenging in small-scale fisheries (SSFs), where endangered species can have important consumptive use values. We used a novel combination of methods – scenario interviews with contingent valuation (CV) – to investigate how incentive-based interventions might influence fisher behaviour and reduce mortality of Critically Endangered taxa (hammerhead sharks (Sphyrna spp.) and wedgefish (Rhynchobatus spp.)) in two case study SSFs in Indonesia. Scenario interviews revealed that positive performance-based incentives were almost unanimously supported (98% and 96% of fishers would stop landing hammerheads and wedgefish, respectively). This is in contrast to 1% and 6% under a business as usual control scenario, and 52% and 46% in response to a regulation with a fine. Using CV, we estimated that an incentive-based scheme for catch mitigation of all hammerheads and wedgefish across both sites could cost US$71,620-298,820 annually, and save up to 18,500 hammerheads and 2,140 wedgefish relative to current catch baselines. This study provides empirical evidence that performance-based payments could offer a cost-effective, legitimate and socially-just approach for marine conservation in SSFs, and support “a sustainable and equitable blue economy” and “living in harmony with nature”. This is particularly important with the growing adoption of net-outcome goals for biodiversity, with studies such as this providing the basis for locally-appropriate investment ready schemes for bycatch-neutral seafood supply chains.

Student Surveys: Measuring the Relationship between Satisfaction and Engagement

This study explores the relationship between satisfaction and engagement survey items through an institutionally based survey, drawing on the two largest higher education student experience surveys in the world. The UK-based National Student Survey (NSS) was designed to inform student choice and drive competition and the US-based National Survey of Student Engagement (NSSE) was developed to provide actionable data for institutional enhancement. Comparing these surveys leads to a critical review of how such data can be used for policy decisions and institutional enhancement. The Institutional Experience Survey thus draws on findings from a survey of 1480 non-final year undergraduate students in a research-intensive UK university. Those who reported higher levels of engagement, measured across 17 engagement benchmarks, also reported significantly higher levels of satisfaction. Results are used to discuss the application of engagement-based surveys in the UK, compared to satisfaction-based surveys, and the benefits and challenges of both approaches. Conclusions are made about the usefulness of nationally standardised experience surveys, the different outcome goals of engagement and satisfaction, such as responsibility for learning and change, audience and results and lessons for other countries looking to measure the student experience. The paper highlights the need for a shift in perspective in relation to the role of student surveys in determining national and institutional policy from a student-as-customer approach to one that sees students and institutions as co-responsible for learning and engagement.

646 Telehealth in Burn Rehabilitation: Virtual Objective Measures

Introduction The COVID-19 pandemic thrusted many burn therapists into the world of telehealth overnight. While telehealth has been widely utilized since and has played a vital role in burn care overall, adaptation of platform has been minimal amongst burn therapists. As more hospital systems integrate telehealth as a service delivery mode, there is a need for guidelines on how to capture data collection and recommended documentation language which indicates progress and justifies therapy. Methods The following virtual visit documentation and objective data collection guidance form was created in an effort to capture ability, disabilities, limitations and barriers of the burn survivor participating in the burn rehabilitative virtual visits. The guidance form is intended to demonstrate examples of data collection can be captured in the virtual environment along with pointers to enhance the experience and recommended documentation language. It is not all inclusive, nor are all the tests listed necessarily required for a successful virtual interaction. (Attachment A) Results Despite the inability to perform formal standardized objective measurements, a burn therapist is still able to measure and document gains and losses. Posture, gait, range of motion, skin integrity, strength, motor control, body mechanics, coordination, adl’s, functional mobility, transfers are a few of the many categories which a burn therapist can focus their documentation. Conclusions When appropriately administered and thoroughly documented telehealth can not only provide quality care to burn survivors but also demonstrate gains to optimal outcome goals and return to baseline levels of independence with ADLs, IADL’s, mobility, transfers, range of motion, strength and sensation.

82 Person-Centred Emergency Care Outcome Measurement For Older People Living with Frailty

Introduction Health outcome goals are the results individuals seek from healthcare. These may incorporate holistic themes including function, mood, and quality of life. People living with frailty have poorer outcomes from even short hospital stays. They benefit from person-centred, goal-directed care over protocol-driven pathway approaches. This could be improved by monitoring attainment of health outcome goals. Methods A systematic review for older people’s health outcome goals in emergency care was conducted using narrative synthesis. A qualitative study based on grounded theory expanded the outcome framework to include people living with frailty. People with cognitive and communication barriers were included in semi-structured interviews. Discussions focussed on the events and outcomes sought from emergency care. Results Older people’s health outcome goals for emergency care were classified as efficient and comprehensive care, sensitivity towards vulnerability, and person-centred informed care. The importance of understanding individual perceptions was explicit. Research generally recruited based on age rather than physiological and functional state, and did not assess for impact of frailty on healthcare perceptions. The interview study was paused due to the COVID-19 pandemic. Initial results showed a predominance of person-centred and holistic care themes among health outcome goals. Participants’ most common goal for emergency care was relief of symptoms: people often had pain. Participants mostly had severe frailty and wanted their mobility to be assessed, with goals of recovering their functional baseline. While participants had confidence in healthcare professionals and were generally willing to “do as we are told to feel better”, they expected to undergo at least basic tests in order to receive a working diagnosis for their problem. People wanted to understand their illness and for explanations to be communicated to their relatives. Next steps Patient-reported outcome measures (PROMs) for this range of emergency care outcomes are being identified for field-testing in acute settings.

Parental Effort and Outcome Goals_Preprint

In many East Asian societies, both Confucian emphasis on effortful learning and the instrumental value of academic grades for attaining social privilege have greatly impacted people’s achievement goals. In this study, we examined whether perceived parental effort goals and outcome goals would function independently from the often noted mastery and performance goals in prior Western literature in explaining East Asian college students’ academic dedication and self-handicapping. The reliability and the construct, concurrent, and incremental validity of newly developed scales for perceived parental effort goals and outcome goals were tested using two samples of Taiwanese students (Ns = 252, 269; 47.6% and 61.7% female; mean age = 20.44, 19.33 years). Results of confirmatory factor analyses supported the four-factor model of effort, outcome, mastery, and performance goals being distinct goal constructs. Hierarchical regression for examining the incremental validity of effort goals and outcome goals indicated that, above and beyond the influence of perceived parental mastery and performance goals, perceived parental effort goals predicted greater self-handicapping behaviors. The inverse effect of perceived parental effort goals in predicting academic adjustment may be explained by students’ sense of academic helplessness, which can be cultivated by prolonged exposure to such parental goals. The regression analyses also found perceived paternal, but not maternal, outcome goals predicted stronger academic dedication, suggesting that East Asian students may interpret paternal interest in test scores as concern for children’s future social and economic wellbeing and perceive similar maternal interest with apprehension.

Changing Safety Net Healthcare Systems to Age-Friendly Healthcare Systems: Lessons Learned

Federally Qualified Health Centers (FQHC) are important safety net providers in disadvantaged communities. As outpatient clinics in these areas, they qualify for specific reimbursement systems under Medicare and Medicaid. Age-friendly health care is an urgent need to be able to provide quality healthcare to more than 46 million Americans age 65 and older, with that number projected to double to more than 98 million by 2060. Friendly healthcare systems require a focus on the 4Ms framework and is focused on improving the health of people at every life stage and in every community across the country. The 4Ms are as follows: 1) What Matters: Aligning care with each older adult’s specific health outcome goals and care preferences; 2) Medications: If medications are necessary, use age-friendly medications that do not interfere with What Matters, Mentation or Mobility; 3) Mentation: Prevent, identify, treat and manage depression, dementia and delirium across settings of care and 4) Mobility: Ensure that older adults move safely every day in order to maintain function and do What Matters. An age-friendly health system is one in which every older adult’s care is guided by these evidence-based practices (the 4Ms), where the care causes no harms, and where the care is consistent with what matters to older adults and their families. In this symposium five Geriatric Workforce Enhancement Programs at five diverse universities will share their experiences with supporting FQHC in their areas to become age-friendly healthcare systems. The unique lessons learned at these different sites will be shared.

How to Manage Performance-Based Contracting

Peter Drucker formulated a management by objectives approach in the 1950s. That approach is a management system based on goal congruence as a means of improving performance. Since then, this management approach developed from leadership of employees to the arena of buyer–supplier relationships, where the approach is called performance-based contracting (PBC) and merges outcome goals with incentives. This chapter briefly introduces the peculiarities and differences of PBC in contrast to more traditional approaches. The chapter indicates that PBC is not just a contract, but in fact a strategic approach, and thus necessitates strategic management activities. Therefore, the focus of this work is on how to manage PBC. For this purpose, the management problem is differentiated into three management needs in two dimensions: The first dimension is the management of the supply architecture. This dimension has two relevant management needs: (a) positioning of PBC and (b) PBC subsupplier management. The second dimension addresses the need for a PBC (project) management in the buyer–supplier relationship. That dimension is further split into ten different steps. To address the management needs, insights from management control theory and new institutional economies theory are used. On this basis, this chapter conceptualizes both management dimensions. Insights about the main decisions for each dimension are given. These insights build the basis for several propositions and managerial implications.

Establishing a “Standard Model” for CALL Instructional Design

This article proposes a Standard Model of CALL, i.e., a compilation of fundamental theories and practices that should always be considered when creating an instructional design for the Computer Assisted Language Learning (CALL). This proposed model is inspired by the standard model of physics which is the widely accepted understanding about how the fundamental particles and forces of the universe operate. The authors propose that the following concepts be considered the foundational components of the Standard Model of CALL which should shape the CALL context: (1) Reverse engineering of instructional requirements from outcome goals; (2) Instructional design based on affordances; (3) Constructivism embodied in student-centered active learning; (4) Communicative Language theory (CLT); (5) Authentic learning materials and experiences, (6) Incremental learning; (7) Task-Based Instructional Design; (8) Gamification; and (9) Long term use via curriculum integration. They collectively form a foundation and framework for common contextual elements that all CALL instructional design should consider.