What matters when it comes to measuring Age-Friendly Health System transformation.

Thousands of health systems are now recognized as "Age-Friendly Health Systems," making this model one of the most widely disseminated - and most promising- models to redesign care delivery for older adults. Sustaining these gains will require demonstrating the impact on care delivery and outcomes of older adults. We propose a new measurement model to more tightly link Age-Friendly Health System transformation to outcomes within each "M" (What Matters, Medications, Mobility, and Mentation). We evaluated measures based on the following characteristics: (1) conceptual responsiveness to changes brought about by practicing "4Ms" care; (2) degree to which they represent outcomes that matter to older adults; and (3) how they can be feasibly, reliably, and validly measured. We offer specific examples of how novel measures are currently being used where available. Finally, we present measures that could capture system-level effects across "M"s. We tie these suggestions together into a conceptual measurement model for AFHS transformation, with the intent to spur discussion, debate, and iterative improvement in measures over time.

Measuring Empathetic Care: Development and Validation of a Self-Report Scale.

PURPOSE: This study describes the development of a self-report survey measure of empathetic care. Empathetic care is defined as caregiving that supports clients' socioemotional capabilities and addresses their emotional needs. It is distinct from instrumental care, which involves assisting with physical needs such as activities of daily living. DESIGN AND METHOD: Based on a literature review, structured interviews, and focus groups, we identify three dimensions of empathetic care: extra-role behavior, emotional support, and relational richness. We then developed a large pool of items that could tap into these dimensions and administered versions of the survey to nearly 300 health care paraprofessionals. RESULTS: After performing exploratory factor analyses on a larger survey of 138 paraprofessionals, a 10-item, three-factor measure, the Empathetic Care Scale (ECS), was developed that predicts decisions on consequential allocation scenarios. A second sample of 125 paraprofessionals provided data for a confirmatory factor analysis; results suggested that the ECS has desirable psychometric properties and evidence of convergent and discriminant validity. Further samples demonstrated acceptable levels of test-retest reliability and no social desirability bias. IMPLICATIONS: This study provides a short self-report measure that can be used to gauge care workers' individual levels of empathetic care. Future research can use this measure to explore relationships between ECS responses and previously proposed but untested outcomes such as patient well-being and employee burnout or turnover rates.