BackgroundAlthough not an inevitable part of ageing, frailty is an increasingly common condition in older people. Frail older patients are particularly vulnerable to the adverse effects of hospitalisation, including deconditioning, immobility and loss of independence (Chong et al, J Am Med Dir Assoc 18:638.e7–638.e11, 2017). The ‘Systematic Approach to improving care for Frail older patients’ (SAFE) study co-designed, with public and patient representatives, quality improvement initiatives aimed at enhancing the delivery of care to frail older patients within an acute hospital setting. This paper describes quality improvement initiatives which resulted from a co-design process aiming to improve service delivery in the acute setting for frail older people. These improvement initiatives were aligned to five priority areas identified by patients and public representatives.MethodsThe co-design work was supported by four pillars of effective and meaningful public and patient representative (PPR) involvement in health research (Bombard et al, Implement Sci 13:98, 2018; Black et al, J Health Serv Res Policy 23:158–67, 2018). These pillars were: research environment and receptive contexts; expectations and role clarity; support for participation and inclusive representation and; commitment to the value of co-learning involving institutional leadership.ResultsFive priority areas were identified by the co-design team for targeted quality improvement initiatives: Collaboration along the integrated care continuum; continence care; improved mobility; access to food and hydration and improved patient information. These priority areas and the responding quality improvement initiatives are discussed in relation to patient-centred outcomes for enhanced care delivery for frail older people in an acute hospital setting.ConclusionsThe co-design approach to quality improvement places patient-centred outcomes such as dignity, identity, respectful communication as well as independence as key drivers for implementation. Enhanced inter-personal communication was consistently emphasised by the co-design team and much of the quality improvement initiatives target more effective, respectful and clear communication between healthcare personnel and patients. Measurement and evaluation of these patient-centred outcomes, while challenging, should be prioritised in the implementation of quality improvement initiatives. Adequate resourcing and administrative commitment pose the greatest challenges to the sustainability of the interventions developed along the SAFE pathways. The inclusion of organisational leadership in the co-design and implementation teams is a critical factor in the success of interventions targeting service delivery and quality improvement.

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Abstracts A56J Epidemiol Community Health 2012;66(Suppl I):A1-A66Conclusion Maternal blood glucose concentrations are associated with birth weight, but the association is complex, reversing as pregnancy progresses. For women with pre-gestational diabetes, maintaining good glucose control throughout pregnancy is likely to be associated with the lowest risk of pathological fetal size. Background Sub-Saharan Africa (SSA) suffers from acute shortages of all types of health workers, partly due to high rates of health workforce migration (HWM) to high-income countries. The role of non-financial incentives in HWM is inadequately defined and their potential as policy levers is overlooked. This study examined the hypothesis that improved local education opportunities could alter the relative uptakes of local and foreign training, ultimately reducing education-led HWM from SSA. Initial qualitative research (reported separately) found that SSA pharmacists valued seven key education-related factors: location (SSA or elsewhere), cost, availability of their preferred course, learning approach (theoretical or practical), course length, access to learning resources (e.g. equipment) and institutional quality. Methods A discrete choice experiment (DCE) was designed to enable quantification of the relative influence of these attributes on SSA pharmacists' education location decisions. Convenience and snowball sampling strategies were necessary, due to limited resources and incomplete sample frames. Participants self-administered a paper-or web-based DCE, comprising 16 labelled choice sets. Each choice set consisted of three hypothetical alternatives: a nominally SSA-based education opportunity (encompassing some splitsite programmes with varying proportions of time spent abroad); a fully foreign-based education opportunity; and a 'delayed choice' option. Hypothetical alternatives were differentiated in each choice set, by varying the levels of the seven education attributes, which represented current and prospective standards for each attribute. Respondents chose one alternative per choice set. The resulting choice data were modelled using the mixed logit model, taking into account respondents' socio-demographic characteristics and varying preferences. Results 428 practising pharmacists and pharmacy students, of SSA origin and any migration status, were recruited in Ghana (faceto-face), the UK and online (both via email). Approximately onethird of respondents displayed unvarying, dominant preferences for one education alternative, regardless of variations in the seven attributes. The preferred alternative in this group was usually the education alternative located fully overseas. Nevertheless, two-thirds of respondents were willing to make at least one trade-off between different levels of different attributes, i.e. the majority of respondents chose the local alternative and the overseas alternative at least once each. Conclusion The results are intended to inform policymakers seeking new and sustainable ways to address the crisis...