Performance measurement for the strategic management of healthcare estates

Purpose The purpose of this study is to explore the role of performance measurement in current practices for strategic management of health-care estates. Design/methodology/approach The research adopts a constructivist grounded theory approach, combining different methodologies of a pan-European qualitative questionnaire, interviews with international health-care providers and a case study of National Health Services (NHS) Scotland. Here, documentation analysis, observations and in-depth interviews involving NHS stakeholders were undertaken. Findings The analysis shows evidence that measuring estate performance has limited value for individual NHS boards regarding strategic decisions related to long-term planning and investment. This was due to design issues and the prioritisation of clinical delivery, which contribute to the neglect of the estate as a consideration in long-term strategic planning. This misalignment results in a tool which is valuable for accountability but which is less helpful to NHS boards in shaping future decisions around the estate. Practical implications Responding to a gap in understanding of the application of performance measurement in the context of health-care estates, this research provides three recommendations to promote a more effective and relevant performance measurement system. These actively recognise the importance of the estate within strategic decision-making as helping to inform the long-term planning and management of the estate within the individual NHS boards. Originality/value This paper shows the current role of performance measurement for the strategic management of health-care estates and identifies issues related to its applicability and value. </jats:sec

Repeatability and validity of a food frequency questionnaire in free-living older people in relation to cognitive function

Objectives: To determine the repeatability and validity of a self-administered, 175-item food frequency questionnaire (FFQ) in free-living older people and to assess whether these are influenced by cognitive function. Participants and setting: 189 free-living people aged 64-80y were recruited from participants in a previous study. Design: To assess repeatability, 102 (52M, 50F) participants completed the FFQ on two occasions three months apart. To assess validity, another 87 participants (44 M, 43 F) completed the FFQ and a four-day weighed diet record three months later. 25 nutrients were studied. Results: For repeatability, Spearman rank correlation coefficients were above 0.35 (p<0.05) for all nutrients. Cohen’s weighted Kappa was above 0.4 for all nutrients except starch, riboflavin, retinol, β-carotene, and calcium. There were no substantial differences in correlation coefficients between sub-groups divided by short-term memory test score. There was no clear pattern for correlation coefficients in sub-groups divided by executive function test score. For validity, the Spearman rank correlation coefficients were above 0.2 (p<0.05) for all nutrients except fat, mono-unsaturated fatty acids, niacin equivalents and vitamin D, and Cohen’s weighted kappa was above 0.4 for alcohol and was above 0.2 for 13 other nutrients. Participants in the lowest-score groups of short-term memory and executive function had the lowest median Spearman correlation coefficient. Conclusions: The FFQ had reasonable repeatability and validity in ranking nutrient intakes in this population though the results varied between nutrients. Poor short-term memory or executive function may affect FFQ validity in ranking nutrient intakes

Sugar intake and dental decay : results from a national survey of children in Scotland

Peer reviewedPreprin

Dietary patterns of school-age children in Scotland : association with socio-economic indicators, physical activity and obesity

Peer reviewedPublisher PD

The Influence of Three Modes of Human Support on Attrition and Adherence to a Web- and Mobile App–Based Mental Health Promotion Intervention in a Nonclinical Cohort: Randomized Comparative Study

Background: The escalating prevalence of mental health disorders necessitates a greater focus on web- and mobile app–based mental health promotion initiatives for nonclinical groups. However, knowledge is scant regarding the influence of human support on attrition and adherence and participant preferences for support in nonclinical settings. Objective: This study aimed to compare the influence of 3 modes of human support on attrition and adherence to a digital mental health intervention for a nonclinical cohort. It evaluated user preferences for support and assessed whether adherence and outcomes were enhanced when participants received their preferred support mode. Methods: Subjects participated in a 10-week digital mental health promotion intervention and were randomized into 3 comparative groups: standard group with automated emails (S), standard plus personalized SMS (S+pSMS), and standard plus weekly videoconferencing support (S+VCS). Adherence was measured by the number of video lessons viewed, points achieved for weekly experiential challenge activities, and the total number of weeks that participants recorded a score for challenges. In the postquestionnaire, participants ranked their preferred human support mode from 1 to 4 (S, S+pSMS, S+VCS, S+pSMS & VCS combined). Stratified analysis was conducted for those who received their first preference. Preintervention and postintervention questionnaires assessed well-being measures (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing). Results: Interested individuals (N=605) enrolled on a website and were randomized into 3 groups (S, n=201; S+pSMS, n=202; S+VCS, n=201). Prior to completing the prequestionnaire, a total of 24.3% (147/605) dropped out. Dropout attrition between groups was significantly different (P=.009): 21.9% (44/201) withdrew from the S group, 19.3% (39/202) from the S+pSMS group, and 31.6% (64/202) from the S+VCS group. The remaining 75.7% (458/605) registered and completed the prequestionnaire (S, n=157; S+pSMS, n=163; S+VCS, n=138). Of the registered participants, 30.1% (138/458) failed to complete the postquestionnaire (S, n=54; S+pSMS, n=49; S+VCS, n=35), but there were no between-group differences (P=.24). For the 69.9% (320/458; S, n=103; S+pSMS, n=114; S+VCS, n=103) who completed the postquestionnaire, no between-group differences in adherence were observed for mean number of videos watched (P=.42); mean challenge scores recorded (P=.71); or the number of weeks that challenge scores were logged (P=.66). A total of 56 participants (17.5%, 56/320) received their first preference in human support (S, n=22; S+pSMS, n=26; S+VCS, n=8). No differences were observed between those who received their first preference and those who did not with regard to video adherence (P=.91); challenge score adherence (P=.27); or any of the well-being measures including, mental health (P=.86), vitality (P=.98), depression (P=.09), anxiety (P=.64), stress (P=.55), life satisfaction (P=.50), and flourishing (P=.47). Conclusions: Early dropout attrition may have been influenced by dissatisfaction with the allocated support mode. Human support mode did not impact adherence to the intervention, and receiving the preferred support style did not result in greater adherence or better outcomes. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.asp

Safe efficacy of three strychnine alkaloid bait concentrations for hand-baiting control of plains pocket gophers

In November 1990, field efficacy studies using milo baits formulated with 0.35%, 0.75%, or 1.30% strychnine alkaloid were compared to a placebo (0.0% strychnine) for controlling plains pocket gophers (Geomys bursarius) near Pleasanton, Texas. These data were required by the US Environmental Protection Agency (EPA) as partial fulfillment for the maintenance of the rodenticide registrations of the US Department of Agriculture. Each of four treatment units (TUs) within a block (2) was randomly assigned one of the four baits. Within each TU, 15 gophers were captured (balanced roughly for gender) and instrumented with radio transmitters. Following a pretreatment acclimation averaging 4.1 days, bait (4 g) was placed in active pocket gopher burrows by hand-baiting. Pocket gopher mortality was measured by monitoring the fate of radio-equipped pocket gophers (n=123) both pretreatment and post-treatment. Lack of gopher movement on two consecutive days indicated death, and the carcass was retrieved. Strychnine mortality was based on chemical analyses of carcasses, and it occurred in 0.0%, 66.7%, 96.3%, and 89.7% of gophers from the 0.0%, 0.35%, 0.75% and 1.30% TUs, respectively. Natural mortality was 7% on the placebo TUs. All three strychnine treatments provided significantly increased mortality over the placebo (P\u3c0.0001) using Fisher\u27s exact test for paired comparisons. A difference in gopher mortality occurred between the 0.32% and 0.77% strychnine treatments (P=0.003), but not between the other comparisons (0.32% vs 1.30%, P=0.18 and 0.77% vs. 1.30%, P=0.24). Gopher carcasses recovered post-treatment indicated 68 of 86 (79.1%) had strychnine alkaloid residues. The non-target strychnine hazard (using least squares means) by treatment were 4.85 ppm (0.35%), 8.04 ppm (0.75%), and 9.47 ppm (1.30%). Carcass residue differences were not detected among strychnine treatments (F=2.48, df=2,3, P=0.23). Fortunately, non-target exposure was greatly decreased because all carcasses with strychnine residues were recovered underground at a mean depth of 0.51 m (SE=0.027, range 0.15–1.17 m). Placebo-baited TUs had 27 survivors and 2 deaths from unknown causes. None had detectable strychnine levels. No non-target mortalities were documented during carcass searches and radio-tracking activities