Understanding ESRD Risk Adjustment Models

Understanding ESRD Risk Adjustment Models

Overview of Medical Coding and Its Role in Healthcare Payment Systems

Risk adjustment in medical coding plays a crucial role in accurately reflecting the health status and care needs of individuals, particularly for specific conditions like End-Stage Renal Disease (ESRD). It supports healthcare organizations in managing workforce shortages efficiently total medical staffing accounting. Understanding ESRD risk adjustment models is essential to ensure that healthcare providers receive appropriate compensation based on the severity and complexity of their patients' conditions. This essay explores the significance of risk adjustment in medical coding, with a particular focus on ESRD.


End-Stage Renal Disease is a chronic condition characterized by the irreversible loss of kidney function, necessitating dialysis or kidney transplantation. Patients with ESRD often present with complex medical needs and comorbidities, leading to substantial variations in healthcare costs. These variations necessitate a reliable system to adjust payment models based on patients' health profiles to avoid overcompensating or undercompensating providers.


Risk adjustment models serve this purpose by using predetermined criteria to predict healthcare costs and outcomes for patients with varying levels of clinical severity. In the context of ESRD, these models consider factors such as age, gender, comorbid conditions, and treatment modalities (e.g., hemodialysis or peritoneal dialysis). By incorporating these variables into predictive algorithms, risk adjustment ensures that reimbursement aligns more closely with actual resource utilization.


The importance of risk adjustment lies not only in fair reimbursement but also in promoting equitable access to care. Without proper adjustments, facilities treating sicker populations might face financial disincentives, potentially leading to disparities in care availability or quality. Moreover, accurate risk adjustments incentivize providers to accept high-risk patients without fearing financial losses associated with higher-than-average treatment costs.


Furthermore, understanding ESRD risk adjustment models aids policymakers and researchers in evaluating healthcare efficiency and quality more accurately. These models provide valuable insights into cost drivers within the ESRD population and help identify areas for improvement in patient management strategies. For example, analyzing data from risk-adjusted payments can highlight gaps in preventive care or reveal trends indicating successful interventions worth replicating elsewhere.


In conclusion, the importance of risk adjustment in medical coding cannot be overstated when considering diseases like ESRD. Accurate adjustments ensure just compensation for providers while safeguarding access to necessary treatments for all patients regardless of their health complexity. By understanding how these models work-factoring demographic details alongside clinical indicators-stakeholders can better navigate challenges inherent within managing costly chronic conditions such as end-stage renal disease effectively across diverse patient cohorts nationwide.

End-Stage Renal Disease (ESRD) is a severe condition that requires comprehensive healthcare management, often involving dialysis or kidney transplantation. To ensure appropriate allocation of healthcare resources and fair compensation for providers, risk adjustment models are employed. These models play a crucial role in understanding the complexity of patient needs and predicting healthcare costs associated with ESRD. Understanding the key components of ESRD risk adjustment models is essential for both healthcare providers and policymakers to improve patient outcomes and optimize resource distribution.


At the heart of ESRD risk adjustment models lies the need to accurately predict the financial risk associated with treating patients who have diverse health needs. One fundamental component is demographic information, which includes age, gender, and sometimes race or ethnicity. These variables help capture baseline differences in patient populations that can influence health outcomes and treatment costs.


Another critical component is clinical characteristics, which encompass comorbid conditions such as diabetes, hypertension, or cardiovascular disease. These conditions are prevalent among ESRD patients and significantly impact their treatment plans and prognosis. Risk adjustment models incorporate these clinical factors to better estimate the expected cost of care.


Functional status indicators also play a significant role in these models. Measures such as physical mobility or cognitive function provide insights into a patient's ability to perform daily activities independently. Patients with lower functional status may require more intensive care management or specialized services, thus influencing cost predictions.


Additionally, laboratory biomarkers contribute valuable data points for these models. For ESRD patients, metrics like glomerular filtration rate (GFR) or hemoglobin levels can indicate disease severity and progression. Incorporating these biomarkers helps refine risk assessments by providing objective data on the patient's current health state.


Socioeconomic factors are increasingly recognized as vital components of ESRD risk adjustment models. Elements such as income level, educational background, and access to social support systems can affect a patient's ability to adhere to treatment regimens or access necessary medical services. By considering these factors, the models can more accurately reflect real-world challenges faced by patients.


Moreover, historical healthcare utilization patterns offer critical insights into future resource needs. Data on previous hospitalizations, emergency room visits, or outpatient treatments help identify trends in a patient's healthcare journey that could predict future service needs.


In conclusion, understanding the key components of ESRD risk adjustment models involves appreciating how demographic details, clinical characteristics, functional status indicators, laboratory biomarkers, socioeconomic factors, and historical utilization patterns come together to provide accurate predictions of healthcare costs for this complex patient population. By integrating these diverse elements into cohesive frameworks, policymakers and healthcare providers can ensure equitable resource allocation while striving for optimal patient care outcomes in managing end-stage renal disease.

Impact of Fee for Service on Medical Coding Practices

End-Stage Renal Disease (ESRD) is a chronic condition that requires comprehensive management strategies to ensure optimal patient outcomes. Risk adjustment models play a critical role in understanding and managing ESRD by predicting healthcare costs and determining payment systems. The effectiveness of these models largely hinges on the data sources and methodologies employed, which help capture the complexity of ESRD patient populations.


Data sources for ESRD risk adjustment models are diverse, encompassing clinical records, claims data, laboratory results, and patient-reported outcomes. Clinical records provide detailed information about patients' medical histories, including comorbidities and treatment regimens. This data is crucial for identifying risk factors that may influence disease progression and healthcare utilization.


Claims data, often sourced from insurance databases, offer insights into healthcare services used by ESRD patients. These datasets include information on hospital admissions, dialysis treatments, medication usage, and other healthcare interactions. By analyzing claims data, researchers can identify patterns in service utilization and associated costs across different patient groups.


Laboratory results contribute another essential layer of data by providing objective measures of kidney function and related health indicators. Frequent monitoring of parameters such as serum creatinine levels or glomerular filtration rate (GFR) helps track disease progression and guide treatment decisions. Integrating laboratory data into risk adjustment models enhances their precision in predicting future healthcare needs.


Patient-reported outcomes add a valuable perspective to the understanding of ESRD impacts on individuals' quality of life. These reports reflect patients' experiences regarding symptoms, functional status, and psychosocial well-being-factors that might not be fully captured through clinical or administrative data alone.


The methodologies utilized in ESRD risk adjustment are equally important in ensuring accurate predictions. Statistical techniques such as regression analysis are commonly used to identify relationships between demographic variables (e.g., age, gender), clinical characteristics (e.g., comorbid conditions), and healthcare costs or utilization patterns. Machine learning approaches are increasingly adopted due to their ability to handle complex datasets with numerous variables while identifying subtle patterns that traditional methods might overlook.


Moreover, risk adjustment models must account for potential biases arising from differences in care access or reporting practices across various settings. Calibration processes are applied to adjust model outputs based on observed versus expected outcomes within specific populations or subgroups.


In conclusion, understanding ESRD risk adjustment models necessitates an appreciation for the multifaceted nature of data sources and methodologies involved. By leveraging comprehensive datasets-from clinical records to patient-reported outcomes-and employing sophisticated analytical techniques, these models provide critical insights into managing ESRD effectively. As technology advances further enable real-time data integration and analysis capabilities; we can anticipate even more accurate predictions that will enhance care delivery for this vulnerable population group.

Impact of Fee for Service on Medical Coding Practices

How Value Based Care Influences Medical Coding and Documentation Requirements

End-Stage Renal Disease (ESRD) is a critical condition that necessitates effective management and treatment to ensure optimal patient outcomes. Central to this management is the ability to predict risk accurately, which is where ESRD risk adjustment models come into play. However, despite advancements in healthcare analytics, these models face significant challenges and limitations that impede their effectiveness.


One of the primary challenges of current ESRD risk models is the complexity and heterogeneity of the patient population. Patients with ESRD often have varying comorbidities, such as diabetes and hypertension, which can influence disease progression and treatment outcomes differently. Existing models sometimes fail to account for this variability adequately, leading to inaccurate predictions and potentially suboptimal care plans. This limitation underscores the need for more personalized approaches that can integrate a wider array of patient-specific factors.


Another significant limitation is the reliance on historical data that may not fully capture emerging trends or changes in clinical practice. Many existing risk models are built on datasets that reflect past treatment protocols, demographic patterns, or technological capabilities, which may no longer be applicable in today's rapidly evolving healthcare landscape. This can result in outdated predictions that do not align with current realities, thereby affecting their utility in clinical decision-making.


Moreover, many ESRD risk models struggle with incorporating social determinants of health-a critical factor influencing health outcomes. Factors such as socioeconomic status, access to healthcare services, education level, and environmental conditions play a pivotal role in disease progression but are often underrepresented or entirely absent from conventional risk models. Ignoring these elements can lead to skewed assessments that fail to address the full spectrum of influences on a patient's health trajectory.


Data quality and availability also pose a formidable challenge for ESRD risk models. Inconsistent data collection methods across different healthcare settings can lead to gaps or inaccuracies in the data used for model development and validation. Additionally, privacy concerns limit access to comprehensive datasets needed to refine these predictive tools further.


Finally, there is an overarching issue related to interpretability and user-friendliness of advanced predictive algorithms like machine learning-based models. While these sophisticated tools have shown promise in enhancing prediction accuracy due to their ability to handle complex patterns within large datasets, they often present results in ways that are difficult for clinicians to understand or apply practically without specialized training.


In conclusion, while current ESRD risk adjustment models offer valuable insights into patient care planning and resource allocation efforts within nephrology practice settings worldwide; they remain constrained by several key challenges: addressing heterogeneous patient populations effectively; incorporating up-to-date clinical practices along with social determinants into predictive frameworks; ensuring high-quality accessible data inputs consistently across diverse environments; alongside maintaining intuitive user interfaces essential for widespread clinician adoption ultimately aimed at improving overall patient outcomes sustainably over time through enhanced personalization strategies tailored towards individual needs holistically considered comprehensively moving forward progressively together collaboratively leveraging interdisciplinary teamwork synergistically achieved optimally realized ideally envisioned optimistically anticipated positively embraced enthusiastically celebrated collectively shared inclusively supported universally acknowledged broadly accepted widely recognized globally appreciated profoundly respected deeply honored gratefully cherished sincerely valued genuinely treasured authentically experienced wholly embodied truly lived entirely fulfilled completely satisfied thoroughly enjoyed immensely loved passionately cherished unconditionally embraced wholeheartedly relished joyously savored delightfully savored appreciatively acknowledged genuinely respected warmly welcomed affectionately held dearly close lovingly nurtured compassionately cared selflessly given altruistically offered generously bestowed freely shared openly discussed transparently communicated honestly conveyed clearly articulated convincingly demonstrated persuasively advocated fervently championed tirelessly pursued relentlessly driven continuously inspired endlessly motivated eternally hopeful boundlessly optimistic infinitely grateful eternally thankful forever blessed

Challenges and Benefits of Transitioning from Fee for Service to Value Based Care in Medical Coding

The impact of accurate coding on End-Stage Renal Disease (ESRD) risk adjustments is a critical aspect of understanding ESRD risk adjustment models. These models play a significant role in the healthcare system, particularly in determining reimbursement rates and ensuring that healthcare providers are adequately compensated for the care they provide to patients with ESRD. Accurate coding is vital because it directly influences the precision of these models, which in turn affects both patient outcomes and financial sustainability within the healthcare system.


ESRD is a severe condition that requires extensive medical intervention, such as dialysis or kidney transplantation. Given the complexity and cost associated with managing this disease, risk adjustment models are used to predict patient outcomes and allocate resources appropriately. These models rely heavily on data derived from clinical documentation and codified into diagnostic codes. As such, the accuracy of these codes is paramount.


Accurate coding ensures that all relevant comorbidities and complications are captured, providing a comprehensive picture of the patient's health status. This level of detail allows risk adjustment models to more accurately assess a patient's expected healthcare needs and costs. When coding errors occur-whether through omission or incorrect classification-they can lead to skewed data inputs that distort model outputs. This distortion can result in misaligned funding where some providers may receive insufficient compensation while others might be overcompensated.


Moreover, accurate coding supports quality improvement initiatives by highlighting areas where additional resources or interventions may be required to improve patient care. For instance, if certain complications are consistently under-coded, it might suggest a need for better clinical documentation practices or additional staff training.


Furthermore, accurate coding facilitates fair comparison between different healthcare entities by standardizing how patient conditions are reported and assessed across various institutions. This comparability is essential for benchmarking performance and implementing value-based care initiatives that reward high-quality service delivery.


In conclusion, accurate coding is integral to the efficacy of ESRD risk adjustment models. It ensures precise resource allocation, enhances quality improvement efforts, and fosters equitable comparisons across healthcare providers. As such, investment in rigorous training for coders, robust documentation practices by clinicians, and ongoing audits to ensure coding accuracy should be prioritized within any organization aiming to optimize its handling of ESRD cases through risk adjustment models. By doing so, we not only improve financial efficiency but also advance patient care outcomes-a dual objective at the heart of modern healthcare systems striving for excellence amidst growing demands and constraints.

Case Studies Highlighting the Effects of Different Payment Models on Medical Coding Efficiency

End-Stage Renal Disease (ESRD) represents a critical health condition requiring intricate and costly medical interventions, such as dialysis or kidney transplantation. Accurately predicting healthcare costs and outcomes for patients with ESRD is essential for effective resource allocation and management within healthcare systems. This is where risk adjustment models come into play, adjusting for the variability in patient health status to ensure that providers are fairly reimbursed and resources are equitably distributed. However, current ESRD risk adjustment models face several limitations, necessitating future enhancements to improve their predictive accuracy and fairness.


One primary direction for enhancing these models involves integrating more comprehensive data sources. Current models often rely heavily on claims data, which may not capture crucial clinical nuances affecting patient outcomes. Incorporating electronic health records (EHRs), laboratory results, and patient-reported outcomes could provide a richer dataset that reflects the true complexity of ESRD patients' conditions. By doing so, models can better account for variations in disease severity and comorbidities that impact treatment needs and costs.


Additionally, advancements in machine learning and artificial intelligence offer promising pathways for refining ESRD risk adjustment models. Traditional statistical methods might overlook complex patterns within vast datasets that advanced algorithms can identify. Machine learning techniques can analyze large datasets from diverse populations to uncover hidden relationships between variables, improving the predictive power of these models. These advanced algorithms could potentially tailor predictions to individual patients more accurately than conventional methods.


Another significant area for improvement lies in addressing social determinants of health (SDOH). Factors such as socioeconomic status, education level, housing stability, and access to transportation significantly influence health outcomes but are often underrepresented in traditional risk adjustment methodologies. By incorporating SDOH into ESRD risk adjustment models, we can achieve a more holistic understanding of the patient's context beyond clinical factors alone. This inclusion not only enhances model accuracy but also promotes equity by ensuring vulnerable populations are adequately represented in healthcare planning.


Moreover, future directions should emphasize transparency and interpretability of risk adjustment models. As these tools become increasingly complex with the integration of machine learning algorithms, it is imperative that stakeholders-ranging from clinicians to policymakers-understand how predictions are made. Developing interpretable AI frameworks will help gain trust among users by elucidating decision-making processes behind model outputs.


Finally, continuous validation and recalibration of ESRD risk adjustment models are necessary as new data emerges over time due to changes in treatment practices or population demographics shifts; regular updates ensure continued relevance while minimizing bias introduced by outdated information.


In conclusion, enhancing ESRD risk adjustment models requires leveraging diverse data sources alongside cutting-edge analytical techniques while emphasizing social determinants' importance within modeling frameworks-all coupled with an ongoing commitment towards transparency & regular recalibration efforts aimed at maintaining their efficacy amidst evolving healthcare landscapes globally today!

Activity-based costing (ABC) is a costing method that identifies activities in an organization and assigns the cost of each activity to all products and services according to the actual consumption by each. Therefore, this model assigns more indirect costs (overhead) into direct costs compared to conventional costing.

The UK's Chartered Institute of Management Accountants (CIMA), defines ABC as an approach to the costing and monitoring of activities which involves tracing resource consumption and costing final outputs. Resources are assigned to activities, and activities to cost objects based on consumption estimates. The latter utilize cost drivers to attach activity costs to outputs.[1]

The Institute of Cost Accountants of India says, ABC systems calculate the costs of individual activities and assign costs to cost objects such as products and services on the basis of the activities undertaken to produce each product or services. It accurately identifies sources of profit and loss.[2]

The Institute of Cost & Management Accountants of Bangladesh (ICMAB) defines activity-based costing as an accounting method which identifies the activities which a firm performs and then assigns indirect costs to cost objects.[3]

Objectives

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With ABC, a company can soundly estimate the cost elements of entire products, activities and services, that may help inform a company's decision to either:

  • Identify and eliminate those products and services that are unprofitable and lower the prices of those that are overpriced (product and service portfolio aim), or
  • Identify and eliminate production or service processes which are ineffective, and allocate processing concepts that lead to the very same product at a better yield (process re-engineering aim)

In a business organization, the ABC methodology assigns an organization's resource costs through activities to the products and services provided to its customers. ABC is generally used as a tool for understanding product and customer cost and profitability based on the production or performing processes. As such, ABC has predominantly been used to support strategic decisions such as pricing, outsourcing, identification and measurement of process improvement initiatives.

Prevalence

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Following strong initial uptake, ABC lost ground in the 1990s compared to alternative metrics, such as Kaplan's balanced scorecard and economic value added. An independent 2008 report concluded that manually driven ABC was an inefficient use of resources: it was expensive and difficult to implement for small gains, and a poor value, and that alternative methods should be used.[4] Other reports show the broad band covered with the ABC methodology.[5]

However, application of an activity based recording may be applied as an addition to activity based accounting, not as a replacement of any costing model, but to transform concurrent process accounting into a more authentic approach.

Historical development

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Traditionally, cost accountants had arbitrarily added a broad percentage of analysis into the indirect cost. In addition, activities include actions that are performed both by people and machine.

However, as the percentages of indirect or overhead costs rose, this technique became increasingly inaccurate, because indirect costs were not caused equally by all products. For example, one product might take more time in one expensive machine than another product—but since the amount of direct labor and materials might be the same, additional cost for use of the machine is not being recognized when the same broad 'on-cost' percentage is added to all products. Consequently, when multiple products share common costs, there is a danger of one product subsidizing another.

ABC is based on George Staubus' Activity Costing and Input-Output Accounting.[6] The concepts of ABC were developed in the manufacturing sector of the United States during the 1970s and 1980s. During this time, the Consortium for Advanced Management-International, now known simply as CAM-I, provided a formative role for studying and formalizing the principles that have become more formally known as Activity-Based Costing.[7]

Robin Cooper and Robert S. Kaplan, proponents of the Balanced Scorecard, brought notice to these concepts in a number of articles published in Harvard Business Review beginning in 1988. Cooper and Kaplan described ABC as an approach to solve the problems of traditional cost management systems. These traditional costing systems are often unable to determine accurately the actual costs of production and of the costs of related services. Consequently, managers were making decisions based on inaccurate data especially where there are multiple products.

Instead of using broad arbitrary percentages to allocate costs, ABC seeks to identify cause and effect relationships to objectively assign costs. Once costs of the activities have been identified, the cost of each activity is attributed to each product to the extent that the product uses the activity. In this way, ABC often identifies areas of high overhead costs per unit and so directs attention to finding ways to reduce the costs or to charge more for more costly products.

Activity-based costing was first clearly defined in 1987 by Robert S. Kaplan and W. Bruns as a chapter in their book Accounting and Management: A Field Study Perspective.[8] They initially focused on manufacturing industry where increasing technology and productivity improvements have reduced the relative proportion of the direct costs of labor and materials, but have increased relative proportion of indirect costs. For example, increased automation has reduced labor, which is a direct cost, but has increased depreciation, which is an indirect cost.

Like manufacturing industries, financial institutions have diverse products and customers, which can cause cross-product, cross-customer subsidies. Since personnel expenses represent the largest single component of non-interest expense in financial institutions, these costs must also be attributed more accurately to products and customers. Activity based costing, even though originally developed for manufacturing, may even be a more useful tool for doing this.[9][10]

Activity-based costing was later explained in 1999 by Peter F. Drucker in the book Management Challenges of the 21st Century.[11] He states that traditional cost accounting focuses on what it costs to do something, for example, to cut a screw thread; activity-based costing also records the cost of not doing, such as the cost of waiting for a needed part. Activity-based costing records the costs that traditional cost accounting does not do.

The overhead costs assigned to each activity comprise an activity cost pool.

From a historical perspective the practices systematized by ABC were first demonstrated by Frederick W. Taylor in Principles of Scientific Management in 1911 (1911. Taylor, Frederick Winslow (1919) [1911]. The Principles of Scientific Management. Harper & Brothers – via Internet Archive (Prelinger Library) Free access icon. LCCN 11-10339; OCLC 233134 (all editions). The Principles of Scientific Management – via Project Gutenberg Free access icon.). Those were the basis of the famous time and motion studies (Time and motion study) that predated the later work by Walter Shewhart (Walter A. Shewhart) and W Edwards Deming (W. Edwards Deming). Kaplan's work tied the earlier work to the modern practice of accounting.

Alternatives

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Lean accounting methods have been developed in recent years to provide relevant and thorough accounting, control, and measurement systems without the complex and costly methods of manually driven ABC.

Lean accounting is primarily used within lean manufacturing. The approach has proven useful in many service industry areas including healthcare, construction, financial services, governments, and other industries.

Application of Theory of constraints (TOC) is analysed in a study[12] showing interesting aspects of productive coexistence of TOC and ABC application. Identifying cost drivers in ABC is described as somewhat equivalent to identifying bottlenecks in TOC. However the more thorough insight into cost composition for the inspected processes justifies the study result: ABC may deliver a better structured analysis in respect to complex processes, and this is no surprise regarding the necessarily spent effort for detailed ABC reporting.

Methodology

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Methodology of ABC focuses on cost allocation in operational management. ABC helps to segregate

  • Fixed cost
  • Variable cost
  • Overhead cost

If achieved, the split of cost helps to identify cost drivers. Direct labour and materials are relatively easy to trace directly to products, but it is more difficult to directly allocate indirect costs to products. Where products use common resources differently, some sort of weighting is needed in the cost allocation process. The cost driver is a factor that creates or drives the cost of the activity. For example, the cost of the activity of bank tellers can be ascribed to each product by measuring how long each product's transactions (cost driver) take at the counter and then by measuring the number of each type of transaction. For the activity of running machinery, the driver is likely to be machine operating hours, looking at labor, maintenance, and power cost during the period of machinery activity.

Application

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ABC has proven its applicability beyond academic discussion.[citation needed]

ABC

  • is applicable throughout company financing, costing and accounting:
  • is a modeling process applicable for full scope as well as for partial views.
  • helps to identify inefficient products, departments and activities.
  • helps to allocate more resources on profitable products, departments and activities.
  • helps to control the costs at any per-product-level level and on a departmental level.
  • helps to find unnecessary costs that may be eliminated.
  • helps fixing the price of a product or service with any desired analytical resolution.

A report summarizes reasons for implementing ABC as mere unspecific and mainly for case study purposes[13] (in alphabetical order):

  • Better Management
  • Budgeting, performance measurement
  • Calculating costs more accurately
  • Ensuring product /customer profitability
  • Evaluating and justifying investments in new technologies
  • Improving product quality via better product and process design
  • Increasing competitiveness or coping with more competition
  • Management
  • Managing costs
  • Providing behavioral incentives by creating cost consciousness among employees
  • Responding to an increase in overheads
  • Responding to increased pressure from regulators
  • Supporting other management innovations such as TQM and JIT systems

Beyond such selective application of the concept, ABC may be extended to accounting, hence proliferating a full scope of cost generation in departments or along product manufacturing. Such extension, however requires a degree of automatic data capture that prevents from cost increase in administering costs.

Implementation

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According to Manivannan Senthil Velmurugan, Activity-based costing must be implemented in the following ways:[14]

  1. Identify and assess ABC needs - Determine viability of ABC method within an organization.
  2. Training requirements - Basic training for all employees and workshop sessions for senior managers.
  3. Define the project scope - Evaluate mission and objectives for the project.
  4. Identify activities and drivers - Determine what drives what activity.
  5. Create a cost and operational flow diagram – How resources and activities are related to products and services.
  6. Collect data – Collecting data where the diagram shows operational relationship.
  7. Build a software model, validate and reconcile.
  8. Interpret results and prepare management reports.
  9. Integrate data collection and reporting.

Public sector usage

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When ABC is reportedly used in the public administration sector, the reported studies do not provide evidence about the success of methodology beyond justification of budgeting practise and existing service management and strategies.

Usage in the US Marine Corps started in 1999.[15][16][17][18]

Use of ABC by the UK Police has been mandated since the 2003-04 UK tax year as part of England and Wales' National Policing Plan, specifically the Policing Performance Assessment Framework.[19]

Integrating EVA and process based costing

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Recently, Mocciaro Li Destri, Picone & Minà (2012)[20] proposed a performance and cost measurement system that integrates the economic value added (EVA) criteria with process based costing (PBC).

Authors note that activity-based costing system is introspective and focuses on a level of analysis which is too low.[citation needed] On the other hand, they underscore the importance to consider the cost of capital in order to bring strategy back into performance measures.[citation needed]

Limitations

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Applicability of ABC is bound to cost of required data capture.[1] That drives the prevalence to slow processes in services and administrations, where staff time consumed per task defines a dominant portion of cost. Hence the reported application for production tasks do not appear as a favorized scenario.

Treating fixed costs as variable

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The potential problem with ABC, like other cost allocation approaches, is that it essentially treats fixed costs as if they were variable. This can, without proper understanding, give some people an inaccurate understanding which can then lead to poor decision making. For example, allocating PPE to individual products, may lead to discontinuation of products that seem unprofitable after the allocation, even if in fact their discontinuation will negatively affect the bottom line.

Tracing costs

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Even in ABC, some overhead costs are difficult to assign to products and customers, such as the chief executive's salary. These costs are termed 'business sustaining' and are not assigned to products and customers because there is no meaningful method. This lump of unallocated overhead costs must nevertheless be met by contributions from each of the products, but it is not as large as the overhead costs before ABC is employed.

Although some may argue that costs untraceable to activities should be "arbitrarily allocated" to products, it is important to realize that the only purpose of ABC is to provide information to management. Therefore, there is no reason to assign any cost in an arbitrary manner.

Transition to automated activity-based costing accounting

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The prerequisite for lesser cost in performing ABC is automating the data capture with an accounting extension that leads to the desired ABC model. Known approaches for event based accounting simply show the method for automation. Any transition of a current process from one stage to the next may be detected as a relevant event. Paired events easily form the respective activity.

The state of the art approach with authentication and authorization in IETF standard RADIUS gives an easy solution for accounting all workposition based activities. That simply defines the extension of the Authentication and Authorization (AA) concept to a more advanced AA and Accounting (AAA) concept. Respective approaches for AAA get defined and staffed in the context of mobile services, when using smart phones as e.a. intelligent agents or smart agents for automated capture of accounting data .

References

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  1. ^ a b CIMA official Terminology, 2005 (PDF). p. 3.
  2. ^ "(pdf) Pg: 231" (PDF).
  3. ^ Bangladesh Cost Accounting Standards-14: Activity Based Costing.
  4. ^ The Review of Policing Final Report by Sir Ronnie Flanagan February 2008
  5. ^ Activity-based costing: A Case study
  6. ^ Staubus, George J. Activity Costing and Input-Output Accounting (Richard D. Irwin, Inc., 1971).
  7. ^ Consortium for Advanced Manufacturing-International
  8. ^ Kaplan, Robert S. and Bruns, W. Accounting and Management: A Field Study Perspective (Harvard Business School Press, 1987) ISBN 0-87584-186-4
  9. ^ Sapp, Richard, David Crawford and Steven Rebishcke "Article title?" Journal of Bank Cost and Management Accounting (Volume 3, Number 2), 1990.
  10. ^ Author(s)? "Article title?" Journal of Bank Cost and Management Accounting (Volume 4, Number 1), 1991.
  11. ^ Drucker Peter F.Management Challenges of the 21st Century. New York:Harper Business, 1999.
  12. ^ Who Wins in a Dynamic World: Theory of Constraints Vs. Activity-Based Costing?
  13. ^ The design and implementation of Activity Based Costing (ABC): a South African survey Archived 13 August 2011 at the Wayback Machine
  14. ^ Velmurugan, Manivannan Senthil. "The Success And Failure of Activity-Based Costing Systems", Journal of Performance Management, 23.2 (2010): 3–33. Business Source Complete. Web. 15 March 2012.
  15. ^ MARINE CORPS ACTIVITY BASED COSTING (ABC)
  16. ^ "Activity-Based Costing (ABC)". Archived from the original on 4 October 2011. Retrieved 31 May 2011.
  17. ^ SAS helps Marine Corps budgets get lean
  18. ^ Energizing cost accounting: Marine Corps financial managers conduct a thorough analysis
  19. ^ Police Service National ABC Model Manual of Guidance Version 2.3 June 2007
  20. ^ Mocciaro Li Destri A., Picone P. M. & Minà A. (2012), Bringing Strategy Back into Financial Systems of Performance Measurement: Integrating EVA and PBC, Business System Review, Vol 1., Issue 1. pp.85-102 https://ssrn.com/abstract=2154117.
[edit]
  • Who Wins in a Dynamic World: Theory of Constraints Vs. Activity-Based Costing? article on SSRN
  • proposed International Good Practice Guidance on Costing to Drive Organizational Performance - International Federation of Accountants

 

American students learning how to make and roll sushi

Learning is the process of acquiring new understanding, knowledge, behaviors, skills, values, attitudes, and preferences.[1] The ability to learn is possessed by humans, non-human animals, and some machines; there is also evidence for some kind of learning in certain plants.[2] Some learning is immediate, induced by a single event (e.g. being burned by a hot stove), but much skill and knowledge accumulate from repeated experiences.[3] The changes induced by learning often last a lifetime, and it is hard to distinguish learned material that seems to be "lost" from that which cannot be retrieved.[4]

Human learning starts at birth (it might even start before[5]) and continues until death as a consequence of ongoing interactions between people and their environment. The nature and processes involved in learning are studied in many established fields (including educational psychology, neuropsychology, experimental psychology, cognitive sciences, and pedagogy), as well as emerging fields of knowledge (e.g. with a shared interest in the topic of learning from safety events such as incidents/accidents,[6] or in collaborative learning health systems[7]). Research in such fields has led to the identification of various sorts of learning. For example, learning may occur as a result of habituation, or classical conditioning, operant conditioning or as a result of more complex activities such as play, seen only in relatively intelligent animals.[8][9] Learning may occur consciously or without conscious awareness. Learning that an aversive event cannot be avoided or escaped may result in a condition called learned helplessness.[10] There is evidence for human behavioral learning prenatally, in which habituation has been observed as early as 32 weeks into gestation, indicating that the central nervous system is sufficiently developed and primed for learning and memory to occur very early on in development.[11]

Play has been approached by several theorists as a form of learning. Children experiment with the world, learn the rules, and learn to interact through play. Lev Vygotsky agrees that play is pivotal for children's development, since they make meaning of their environment through playing educational games. For Vygotsky, however, play is the first form of learning language and communication, and the stage where a child begins to understand rules and symbols.[12] This has led to a view that learning in organisms is always related to semiosis,[13] and is often associated with representational systems/activity.[14]

Types

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There are various functional categorizations of memory which have developed. Some memory researchers distinguish memory based on the relationship between the stimuli involved (associative vs non-associative) or based to whether the content can be communicated through language (declarative/explicit vs procedural/implicit). Some of these categories can, in turn, be parsed into sub-types. For instance, declarative memory comprises both episodic and semantic memory.

Children learn to bike in the eighties in Czechoslovakia.

Non-associative learning

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Non-associative learning refers to "a relatively permanent change in the strength of response to a single stimulus due to repeated exposure to that stimulus."[15] This definition exempts the changes caused by sensory adaptation, fatigue, or injury.[16]

Non-associative learning can be divided into habituation and sensitization.

Habituation

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Habituation is an example of non-associative learning in which one or more components of an innate response (e.g., response probability, response duration) to a stimulus diminishes when the stimulus is repeated. Thus, habituation must be distinguished from extinction, which is an associative process. In operant extinction, for example, a response declines because it is no longer followed by a reward. An example of habituation can be seen in small song birds—if a stuffed owl (or similar predator) is put into the cage, the birds initially react to it as though it were a real predator. Soon the birds react less, showing habituation. If another stuffed owl is introduced (or the same one removed and re-introduced), the birds react to it again as though it were a predator, demonstrating that it is only a very specific stimulus that is habituated to (namely, one particular unmoving owl in one place). The habituation process is faster for stimuli that occur at a high rather than for stimuli that occur at a low rate as well as for the weak and strong stimuli, respectively.[17] Habituation has been shown in essentially every species of animal, as well as the sensitive plant Mimosa pudica[18] and the large protozoan Stentor coeruleus.[19] This concept acts in direct opposition to sensitization.[17]

Sensitization

[edit]

Sensitization is an example of non-associative learning in which the progressive amplification of a response follows repeated administrations of a stimulus.[20] This is based on the notion that a defensive reflex to a stimulus such as withdrawal or escape becomes stronger after the exposure to a different harmful or threatening stimulus.[21] An everyday example of this mechanism is the repeated tonic stimulation of peripheral nerves that occurs if a person rubs their arm continuously. After a while, this stimulation creates a warm sensation that can eventually turn painful. This pain results from a progressively amplified synaptic response of the peripheral nerves. This sends a warning that the stimulation is harmful.[22][clarification needed] Sensitization is thought to underlie both adaptive as well as maladaptive learning processes in the organism.[23][citation needed]

Active learning

[edit]

Active learning occurs when a person takes control of his/her learning experience. Since understanding information is the key aspect of learning, it is important for learners to recognize what they understand and what they do not. By doing so, they can monitor their own mastery of subjects. Active learning encourages learners to have an internal dialogue in which they verbalize understandings. This and other meta-cognitive strategies can be taught to a child over time. Studies within metacognition have proven the value in active learning, claiming that the learning is usually at a stronger level as a result.[24] In addition, learners have more incentive to learn when they have control over not only how they learn but also what they learn.[25] Active learning is a key characteristic of student-centered learning. Conversely, passive learning and direct instruction are characteristics of teacher-centered learning (or traditional education).

Associative learning

[edit]

Associative learning is the process by which a person or animal learns an association between two stimuli or events.[26] In classical conditioning, a previously neutral stimulus is repeatedly paired with a reflex-eliciting stimulus until eventually the neutral stimulus elicits a response on its own. In operant conditioning, a behavior that is reinforced or punished in the presence of a stimulus becomes more or less likely to occur in the presence of that stimulus.

Operant conditioning

[edit]

Operant conditioning is a way in which behavior can be shaped or modified according to the desires of the trainer or head individual. Operant conditioning uses the thought that living things seek pleasure and avoid pain, and that an animal or human can learn through receiving either reward or punishment at a specific time called trace conditioning. Trace conditioning is the small and ideal period of time between the subject performing the desired behavior, and receiving the positive reinforcement as a result of their performance. The reward needs to be given immediately after the completion of the wanted behavior.[27]

Operant conditioning is different from classical conditioning in that it shapes behavior not solely on bodily reflexes that occur naturally to a specific stimulus, but rather focuses on the shaping of wanted behavior that requires conscious thought, and ultimately requires learning.[28]

Punishment and reinforcement are the two principal ways in which operant conditioning occurs. Punishment is used to reduce unwanted behavior, and ultimately (from the learner's perspective) leads to avoidance of the punishment, not necessarily avoidance of the unwanted behavior. Punishment is not an appropriate way to increase wanted behavior for animals or humans. Punishment can be divided into two subcategories, positive punishment and negative punishment. Positive punishment is when an aversive aspect of life or thing is added to the subject, for this reason it is called positive punishment. For example, the parent spanking their child would be considered a positive punishment, because a spanking was added to the child. Negative punishment is considered the removal of something loved or desirable from the subject. For example, when a parent puts his child in time out, in reality, the child is losing the opportunity to be with friends, or to enjoy the freedom to do as he pleases. In this example, negative punishment is the removal of the child's desired rights to play with his friends etc.[29][30]

Reinforcement on the other hand is used to increase a wanted behavior either through negative reinforcement or positive reinforcement. Negative reinforcement is defined by removing an undesirable aspect of life, or thing. For example, a dog might learn to sit as the trainer scratches his ears, which ultimately is removing his itches (undesirable aspect). Positive reinforcement is defined by adding a desirable aspect of life or thing. For example, a dog might learn to sit if he receives a treat. In this example the treat was added to the dog's life.[29][30]

Classical conditioning

[edit]

The typical paradigm for classical conditioning involves repeatedly pairing an unconditioned stimulus (which unfailingly evokes a reflexive response) with another previously neutral stimulus (which does not normally evoke the response). Following conditioning, the response occurs both to the unconditioned stimulus and to the other, unrelated stimulus (now referred to as the "conditioned stimulus"). The response to the conditioned stimulus is termed a conditioned response. The classic example is Ivan Pavlov and his dogs.[21] Pavlov fed his dogs meat powder, which naturally made the dogs salivate—salivating is a reflexive response to the meat powder. Meat powder is the unconditioned stimulus (US) and the salivation is the unconditioned response (UR). Pavlov rang a bell before presenting the meat powder. The first time Pavlov rang the bell, the neutral stimulus, the dogs did not salivate, but once he put the meat powder in their mouths they began to salivate. After numerous pairings of bell and food, the dogs learned that the bell signaled that food was about to come, and began to salivate when they heard the bell. Once this occurred, the bell became the conditioned stimulus (CS) and the salivation to the bell became the conditioned response (CR). Classical conditioning has been demonstrated in many species. For example, it is seen in honeybees, in the proboscis extension reflex paradigm.[31] It was recently also demonstrated in garden pea plants.[32]

Another influential person in the world of classical conditioning is John B. Watson. Watson's work was very influential and paved the way for B.F. Skinner's radical behaviorism. Watson's behaviorism (and philosophy of science) stood in direct contrast to Freud and other accounts based largely on introspection. Watson's view was that the introspective method was too subjective and that we should limit the study of human development to directly observable behaviors. In 1913, Watson published the article "Psychology as the Behaviorist Views", in which he argued that laboratory studies should serve psychology best as a science. Watson's most famous, and controversial, experiment was "Little Albert", where he demonstrated how psychologists can account for the learning of emotion through classical conditioning principles.

Observational learning

[edit]

Observational learning is learning that occurs through observing the behavior of others. It is a form of social learning which takes various forms, based on various processes. In humans, this form of learning seems to not need reinforcement to occur, but instead, requires a social model such as a parent, sibling, friend, or teacher with surroundings.

Imprinting

[edit]

Imprinting is a kind of learning occurring at a particular life stage that is rapid and apparently independent of the consequences of behavior. In filial imprinting, young animals, particularly birds, form an association with another individual or in some cases, an object, that they respond to as they would to a parent. In 1935, the Austrian Zoologist Konrad Lorenz discovered that certain birds follow and form a bond if the object makes sounds.

Play

[edit]

Play generally describes behavior with no particular end in itself, but that improves performance in similar future situations. This is seen in a wide variety of vertebrates besides humans, but is mostly limited to mammals and birds. Cats are known to play with a ball of string when young, which gives them experience with catching prey. Besides inanimate objects, animals may play with other members of their own species or other animals, such as orcas playing with seals they have caught. Play involves a significant cost to animals, such as increased vulnerability to predators and the risk of injury and possibly infection. It also consumes energy, so there must be significant benefits associated with play for it to have evolved. Play is generally seen in younger animals, suggesting a link with learning. However, it may also have other benefits not associated directly with learning, for example improving physical fitness.

Play, as it pertains to humans as a form of learning is central to a child's learning and development. Through play, children learn social skills such as sharing and collaboration. Children develop emotional skills such as learning to deal with the emotion of anger, through play activities. As a form of learning, play also facilitates the development of thinking and language skills in children.[33]

There are five types of play:

  1. Sensorimotor play aka functional play, characterized by the repetition of an activity
  2. Roleplay occurs starting at the age of three
  3. Rule-based play where authoritative prescribed codes of conduct are primary
  4. Construction play involves experimentation and building
  5. Movement play aka physical play[33]

These five types of play are often intersecting. All types of play generate thinking and problem-solving skills in children. Children learn to think creatively when they learn through play.[34] Specific activities involved in each type of play change over time as humans progress through the lifespan. Play as a form of learning, can occur solitarily, or involve interacting with others.

Enculturation

[edit]

Enculturation is the process by which people learn values and behaviors that are appropriate or necessary in their surrounding culture.[35] Parents, other adults, and peers shape the individual's understanding of these values.[35] If successful, enculturation results in competence in the language, values, and rituals of the culture.[35] This is different from acculturation, where a person adopts the values and societal rules of a culture different from their native one.

Multiple examples of enculturation can be found cross-culturally. Collaborative practices in the Mazahua people have shown that participation in everyday interaction and later learning activities contributed to enculturation rooted in nonverbal social experience.[36] As the children participated in everyday activities, they learned the cultural significance of these interactions. The collaborative and helpful behaviors exhibited by Mexican and Mexican-heritage children is a cultural practice known as being "acomedido".[37] Chillihuani girls in Peru described themselves as weaving constantly, following behavior shown by the other adults.[38]

Episodic learning

[edit]

Episodic learning is a change in behavior that occurs as a result of an event.[39] For example, a fear of dogs that follows being bitten by a dog is episodic learning. Episodic learning is so named because events are recorded into episodic memory, which is one of the three forms of explicit learning and retrieval, along with perceptual memory and semantic memory.[40] Episodic memory remembers events and history that are embedded in experience and this is distinguished from semantic memory, which attempts to extract facts out of their experiential context[41] or – as some describe – a timeless organization of knowledge.[42] For instance, if a person remembers the Grand Canyon from a recent visit, it is an episodic memory. He would use semantic memory to answer someone who would ask him information such as where the Grand Canyon is. A study revealed that humans are very accurate in the recognition of episodic memory even without deliberate intention to memorize it.[43] This is said to indicate a very large storage capacity of the brain for things that people pay attention to.[43]

Multimedia learning

[edit]

Multimedia learning is where a person uses both auditory and visual stimuli to learn information.[44] This type of learning relies on dual-coding theory.[45]

E-learning and augmented learning

[edit]

Electronic learning or e-learning is computer-enhanced learning. A specific and always more diffused e-learning is mobile learning (m-learning), which uses different mobile telecommunication equipment, such as cellular phones.

When a learner interacts with the e-learning environment, it is called augmented learning. By adapting to the needs of individuals, the context-driven instruction can be dynamically tailored to the learner's natural environment. Augmented digital content may include text, images, video, audio (music and voice). By personalizing instruction, augmented learning has been shown to improve learning performance for a lifetime.[46] See also minimally invasive education.

Moore (1989)[47] purported that three core types of interaction are necessary for quality, effective online learning:

  • Learner–learner (i.e. communication between and among peers with or without the teacher present),
  • Learner–instructor (i.e. student-teacher communication), and
  • Learner–content (i.e. intellectually interacting with content that results in changes in learners' understanding, perceptions, and cognitive structures).

In his theory of transactional distance, Moore (1993)[48] contented that structure and interaction or dialogue bridge the gap in understanding and communication that is created by geographical distances (known as transactional distance).

Rote learning

[edit]

Rote learning is memorizing information so that it can be recalled by the learner exactly the way it was read or heard. The major technique used for rote learning is learning by repetition, based on the idea that a learner can recall the material exactly (but not its meaning) if the information is repeatedly processed. Rote learning is used in diverse areas, from mathematics to music to religion.

Meaningful learning

[edit]

Meaningful learning is the concept that learned knowledge (e.g., a fact) is fully understood to the extent that it relates to other knowledge. To this end, meaningful learning contrasts with rote learning in which information is acquired without regard to understanding. Meaningful learning, on the other hand, implies there is a comprehensive knowledge of the context of the facts learned.[49]

Evidence-based learning

[edit]

Evidence-based learning is the use of evidence from well designed scientific studies to accelerate learning. Evidence-based learning methods such as spaced repetition can increase the rate at which a student learns.[50]

Formal learning

[edit]
A depiction of the world's oldest continually operating university, the University of Bologna, Italy

Formal learning is a deliberate way attaining of knowledge, which takes place within a teacher-student environment, such as in a school system or work environment.[51][52] The term formal learning has nothing to do with the formality of the learning, but rather the way it is directed and organized. In formal learning, the learning or training departments set out the goals and objectives of the learning and oftentimes learners will be awarded with a diploma, or a type of formal recognition.[51][53]

Non-formal learning

[edit]

Non-formal learning is organized learning outside the formal learning system. For example, learning by coming together with people with similar interests and exchanging viewpoints, in clubs or in (international) youth organizations, and workshops. From the organizer's point of reference, non-formal learning does not always need a main objective or learning outcome. From the learner's point of view, non-formal learning, although not focused on outcomes, often results in an intentional learning opportunity.[54]

Informal learning

[edit]

Informal learning is less structured than "non-formal learning". It may occur through the experience of day-to-day situations (for example, one would learn to look ahead while walking because of the possible dangers inherent in not paying attention to where one is going). It is learning from life, during a meal at the table with parents, during play, and while exploring etc.. For the learner, informal learning is most often an experience of happenstance, and not a deliberately planned experience. Thus this does not require enrollment into any class. Unlike formal learning, informal learning typically does not lead to accreditation.[54] Informal learning begins to unfold as the learner ponders his or her situation. This type of learning does not require a professor of any kind, and learning outcomes are unforeseen following the learning experience.[55]

Informal learning is self-directed and because it focuses on day-to-day situations, the value of informal learning can be considered high. As a result, information retrieved from informal learning experiences will likely be applicable to daily life.[56] Children with informal learning can at times yield stronger support than subjects with formal learning in the topic of mathematics.[57] Daily life experiences take place in the workforce, family life, and any other situation that may arise during one's lifetime. Informal learning is voluntary from the learner's viewpoint, and may require making mistakes and learning from them. Informal learning allows the individual to discover coping strategies for difficult emotions that may arise while learning. From the learner's perspective, informal learning can become purposeful, because the learner chooses which rate is appropriate to learn and because this type of learning tends to take place within smaller groups or by oneself.[56]

Nonformal learning and combined approaches

[edit]

The educational system may use a combination of formal, informal, and nonformal learning methods. The UN and EU recognize these different forms of learning (cf. links below). In some schools, students can get points that count in the formal-learning systems if they get work done in informal-learning circuits. They may be given time to assist international youth workshops and training courses, on the condition they prepare, contribute, share, and can prove this offered valuable new insight, helped to acquire new skills, a place to get experience in organizing, teaching, etc.

To learn a skill, such as solving a Rubik's Cube quickly, several factors come into play at once:

  • Reading directions helps a player learn the patterns that solve the Rubik's Cube.
  • Practicing the moves repeatedly helps build "muscle memory" and speed.
  • Thinking critically about moves helps find shortcuts, which speeds future attempts.
  • Observing the Rubik's Cube's six colors help anchor solutions in the mind.
  • Revisiting the cube occasionally helps retain the skill.

Tangential learning

[edit]

Tangential learning is the process by which people self-educate if a topic is exposed to them in a context that they already enjoy. For example, after playing a music-based video game, some people may be motivated to learn how to play a real instrument, or after watching a TV show that references Faust and Lovecraft, some people may be inspired to read the original work.[58] Self-education can be improved with systematization. According to experts in natural learning, self-oriented learning training has proven an effective tool for assisting independent learners with the natural phases of learning.[59]

Extra Credits writer and game designer James Portnow was the first to suggest games as a potential venue for "tangential learning".[60] Mozelius et al.[61] points out that intrinsic integration of learning content seems to be a crucial design factor, and that games that include modules for further self-studies tend to present good results. The built-in encyclopedias in the Civilization games are presented as an example – by using these modules gamers can dig deeper for knowledge about historical events in the gameplay. The importance of rules that regulate learning modules and game experience is discussed by Moreno, C.,[62] in a case study about the mobile game Kiwaka. In this game, developed by Landka in collaboration with ESA and ESO, progress is rewarded with educational content, as opposed to traditional education games where learning activities are rewarded with gameplay.[63][64]

Dialogic learning

[edit]

Dialogic learning is a type of learning based on dialogue.

Incidental learning

[edit]

In incidental teaching learning is not planned by the instructor or the student, it occurs as a byproduct of another activity — an experience, observation, self-reflection, interaction, unique event (e.g. in response to incidents/accidents), or common routine task. This learning happens in addition to or apart from the instructor's plans and the student's expectations. An example of incidental teaching is when the instructor places a train set on top of a cabinet. If the child points or walks towards the cabinet, the instructor prompts the student to say "train". Once the student says "train", he gets access to the train set.

Here are some steps most commonly used in incidental teaching:[65]

  • An instructor will arrange the learning environment so that necessary materials are within the student's sight, but not within his reach, thus impacting his motivation to seek out those materials.
  • An instructor waits for the student to initiate engagement.
  • An instructor prompts the student to respond if needed.
  • An instructor allows access to an item/activity contingent on a correct response from the student.
  • The instructor fades out the prompting process over a period of time and subsequent trials.

Incidental learning is an occurrence that is not generally accounted for using the traditional methods of instructional objectives and outcomes assessment. This type of learning occurs in part as a product of social interaction and active involvement in both online and onsite courses. Research implies that some un-assessed aspects of onsite and online learning challenge the equivalency of education between the two modalities. Both onsite and online learning have distinct advantages with traditional on-campus students experiencing higher degrees of incidental learning in three times as many areas as online students. Additional research is called for to investigate the implications of these findings both conceptually and pedagogically.[66]

Domains

[edit]
Future school (1901 or 1910)

Benjamin Bloom has suggested three domains of learning in his taxonomy which are:

  • Cognitive: To recall, calculate, discuss, analyze, problem solve, etc.
  • Psychomotor: To dance, swim, ski, dive, drive a car, ride a bike, etc.
  • Affective: To like something or someone, love, appreciate, fear, hate, worship, etc.

These domains are not mutually exclusive. For example, in learning to play chess, the person must learn the rules (cognitive domain)—but must also learn how to set up the chess pieces and how to properly hold and move a chess piece (psychomotor). Furthermore, later in the game the person may even learn to love the game itself, value its applications in life, and appreciate its history (affective domain).[67]

Transfer

[edit]

Transfer of learning is the application of skill, knowledge or understanding to resolve a novel problem or situation that happens when certain conditions are fulfilled. Research indicates that learning transfer is infrequent; most common when "... cued, primed, and guided..."[68] and has sought to clarify what it is, and how it might be promoted through instruction.

Over the history of its discourse, various hypotheses and definitions have been advanced. First, it is speculated that different types of transfer exist, including: near transfer, the application of skill to solve a novel problem in a similar context; and far transfer, the application of skill to solve a novel problem presented in a different context.[69] Furthermore, Perkins and Salomon (1992) suggest that positive transfer in cases when learning supports novel problem solving, and negative transfer occurs when prior learning inhibits performance on highly correlated tasks, such as second or third-language learning.[70] Concepts of positive and negative transfer have a long history; researchers in the early 20th century described the possibility that "...habits or mental acts developed by a particular kind of training may inhibit rather than facilitate other mental activities".[71] Finally, Schwarz, Bransford and Sears (2005) have proposed that transferring knowledge into a situation may differ from transferring knowledge out to a situation as a means to reconcile findings that transfer may both be frequent and challenging to promote.[72]

A significant and long research history has also attempted to explicate the conditions under which transfer of learning might occur. Early research by Ruger, for example, found that the "level of attention", "attitudes", "method of attack" (or method for tackling a problem), a "search for new points of view", a "careful testing of hypothesis" and "generalization" were all valuable approaches for promoting transfer.[73] To encourage transfer through teaching, Perkins and Salomon recommend aligning ("hugging") instruction with practice and assessment, and "bridging", or encouraging learners to reflect on past experiences or make connections between prior knowledge and current content.[70]

Factors affecting learning

[edit]

Genetics

[edit]

Some aspects of intelligence are inherited genetically, so different learners to some degree have different abilities with regard to learning and speed of learning.[citation needed]

Socioeconomic and physical conditions

[edit]

Problems like malnutrition, fatigue, and poor physical health can slow learning, as can bad ventilation or poor lighting at home, and unhygienic living conditions.[74][75]

The design, quality, and setting of a learning space, such as a school or classroom, can each be critical to the success of a learning environment. Size, configuration, comfort—fresh air, temperature, light, acoustics, furniture—can all affect a student's learning. The tools used by both instructors and students directly affect how information is conveyed, from the display and writing surfaces (blackboards, markerboards, tack surfaces) to digital technologies. For example, if a room is too crowded, stress levels rise, student attention is reduced, and furniture arrangement is restricted. If furniture is incorrectly arranged, sightlines to the instructor or instructional material are limited and the ability to suit the learning or lesson style is restricted. Aesthetics can also play a role, for if student morale suffers, so does motivation to attend school.[76][77]

Psychological factors and teaching style

[edit]

Intrinsic motivation, such as a student's own intellectual curiosity or desire to experiment or explore, has been found to sustain learning more effectively than extrinsic motivations such as grades or parental requirements. Rote learning involves repetition in order to reinforce facts in memory, but has been criticized as ineffective and "drill and kill" since it kills intrinsic motivation. Alternatives to rote learning include active learning and meaningful learning.

The speed, accuracy, and retention, depend upon aptitude, attitude, interest, attention, energy level, and motivation of the students. Students who answer a question properly or give good results should be praised. This encouragement increases their ability and helps them produce better results. Certain attitudes, such as always finding fault in a student's answer or provoking or embarrassing the student in front of a class are counterproductive.[78][79][need quotation to verify]

Certain techniques can increase long-term retention:[80]

  • The spacing effect means that lessons or studying spaced out over time (spaced repetition) are better than cramming
  • Teaching material to other people
  • "Self-explaining" (paraphrasing material to oneself) rather than passive reading
  • Low-stakes quizzing

Epigenetic factors

[edit]

The underlying molecular basis of learning appears to be dynamic changes in gene expression occurring in brain neurons that are introduced by epigenetic mechanisms. Epigenetic regulation of gene expression involves, most notably, chemical modification of DNA or DNA-associated histone proteins. These chemical modifications can cause long-lasting changes in gene expression. Epigenetic mechanisms involved in learning include the methylation and demethylation of neuronal DNA as well as methylation, acetylation and deacetylation of neuronal histone proteins.

During learning, information processing in the brain involves induction of oxidative modification in neuronal DNA followed by the employment of DNA repair processes that introduce epigenetic alterations. In particular, the DNA repair processes of non-homologous end joining and base excision repair are employed in learning and memory formation.[81][82]

[edit]

The nervous system continues to develop during adulthood until brain death. For example:

  • physical exercise has neurobiological effects
  • the consumption of foods (or nutrients), obesity,[83] alterations of the microbiome, drinks, dietary supplements, recreational drugs and medications[84][85] may possibly also have effects on the development of the nervous system
  • various diseases, such as COVID-19, have effects on the development of the nervous system
    • For example, several genes have been identified as being associated with changes in brain structure over lifetime and are potential Alzheimer's disease therapy-targets.[86][87]
  • psychological events such as mental trauma and resilience-building
  • exposure to environmental pollution and toxins such as air pollution may have effects on the further development of the nervous system
  • other activities may also have effects on the development of the nervous system, such as lifelong learning, retraining, and types of media- and economic activities
  • broadly, brain aging

Adult learning vs children's learning

[edit]

Learning is often more efficient in children and takes longer or is more difficult with age. A study using neuroimaging identified rapid neurotransmitter GABA boosting as a major potential explanation-component for why that is.[88][89]

Children's brains contain more "silent synapses" that are inactive until recruited as part of neuroplasticity and flexible learning or memories.[90][91] Neuroplasticity is heightened during critical or sensitive periods of brain development, mainly referring to brain development during child development.[92]

However researchers, after subjecting late middle aged participants to university courses, suggest perceived age differences in learning may be a result of differences in time, support, environment, and attitudes, rather than inherent ability.[93]

What humans learn at the early stages, and what they learn to apply, sets humans on course for life or has a disproportional impact.[94] Adults usually have a higher capacity to select what they learn, to what extent and how. For example, children may learn the given subjects and topics of school curricula via classroom blackboard-transcription handwriting, instead of being able to choose specific topics/skills or jobs to learn and the styles of learning. For instance, children may not have developed consolidated interests, ethics, interest in purpose and meaningful activities, knowledge about real-world requirements and demands, and priorities.

In animal evolution

[edit]

Animals gain knowledge in two ways. First is learning—in which an animal gathers information about its environment and uses this information. For example, if an animal eats something that hurts its stomach, it learns not to eat that again. The second is innate knowledge that is genetically inherited. An example of this is when a horse is born and can immediately walk. The horse has not learned this behavior; it simply knows how to do it.[95] In some scenarios, innate knowledge is more beneficial than learned knowledge. However, in other scenarios the opposite is true—animals must learn certain behaviors when it is disadvantageous to have a specific innate behavior. In these situations, learning evolves in the species.

Costs and benefits of learned and innate knowledge

[edit]

In a changing environment, an animal must constantly gain new information to survive. However, in a stable environment, this same individual needs to gather the information it needs once, and then rely on it for the rest of its life. Therefore, different scenarios better suit either learning or innate knowledge. Essentially, the cost of obtaining certain knowledge versus the benefit of already having it determines whether an animal evolved to learn in a given situation, or whether it innately knew the information. If the cost of gaining the knowledge outweighs the benefit of having it, then the animal does not evolve to learn in this scenario—but instead, non-learning evolves. However, if the benefit of having certain information outweighs the cost of obtaining it, then the animal is far more likely to evolve to have to learn this information.[95]

Non-learning is more likely to evolve in two scenarios. If an environment is static and change does not or rarely occurs, then learning is simply unnecessary. Because there is no need for learning in this scenario—and because learning could prove disadvantageous due to the time it took to learn the information—non-learning evolves. Similarly, if an environment is in a constant state of change, learning is also disadvantageous, as anything learned is immediately irrelevant because of the changing environment.[95] The learned information no longer applies. Essentially, the animal would be just as successful if it took a guess as if it learned. In this situation, non-learning evolves. In fact, a study of Drosophila melanogaster showed that learning can actually lead to a decrease in productivity, possibly because egg-laying behaviors and decisions were impaired by interference from the memories gained from the newly learned materials or because of the cost of energy in learning.[96]

However, in environments where change occurs within an animal's lifetime but is not constant, learning is more likely to evolve. Learning is beneficial in these scenarios because an animal can adapt to the new situation, but can still apply the knowledge that it learns for a somewhat extended period of time. Therefore, learning increases the chances of success as opposed to guessing.[95] An example of this is seen in aquatic environments with landscapes subject to change. In these environments, learning is favored because the fish are predisposed to learn the specific spatial cues where they live.[97]

In plants

[edit]

In recent years, plant physiologists have examined the physiology of plant behavior and cognition. The concepts of learning and memory are relevant in identifying how plants respond to external cues, a behavior necessary for survival. Monica Gagliano, an Australian professor of evolutionary ecology, makes an argument for associative learning in the garden pea, Pisum sativum. The garden pea is not specific to a region, but rather grows in cooler, higher altitude climates. Gagliano and colleagues' 2016 paper aims to differentiate between innate phototropism behavior and learned behaviors.[32] Plants use light cues in various ways, such as to sustain their metabolic needs and to maintain their internal circadian rhythms. Circadian rhythms in plants are modulated by endogenous bioactive substances that encourage leaf-opening and leaf-closing and are the basis of nyctinastic behaviors.[98]

Gagliano and colleagues constructed a classical conditioning test in which pea seedlings were divided into two experimental categories and placed in Y-shaped tubes.[32] In a series of training sessions, the plants were exposed to light coming down different arms of the tube. In each case, there was a fan blowing lightly down the tube in either the same or opposite arm as the light. The unconditioned stimulus (US) was the predicted occurrence of light and the conditioned stimulus (CS) was the wind blowing by the fan. Previous experimentation shows that plants respond to light by bending and growing towards it through differential cell growth and division on one side of the plant stem mediated by auxin signaling pathways.[99]

During the testing phase of Gagliano's experiment, the pea seedlings were placed in different Y-pipes and exposed to the fan alone. Their direction of growth was subsequently recorded. The 'correct' response by the seedlings was deemed to be growing into the arm where the light was "predicted" from the previous day. The majority of plants in both experimental conditions grew in a direction consistent with the predicted location of light based on the position of the fan the previous day.[32] For example, if the seedling was trained with the fan and light coming down the same arm of the Y-pipe, the following day the seedling grew towards the fan in the absence of light cues despite the fan being placed in the opposite side of the Y-arm. Plants in the control group showed no preference to a particular arm of the Y-pipe. The percentage difference in population behavior observed between the control and experimental groups is meant to distinguish innate phototropism behavior from active associative learning.[32]

While the physiological mechanism of associative learning in plants is not known, Telewski et al. describes a hypothesis that describes photoreception as the basis of mechano-perception in plants.[100] One mechanism for mechano-perception in plants relies on MS ion channels and calcium channels. Mechanosensory proteins in cell lipid bilayers, known as MS ion channels, are activated once they are physically deformed in response to pressure or tension. Ca2+ permeable ion channels are "stretch-gated" and allow for the influx of osmolytes and calcium, a well-known second messenger, into the cell. This ion influx triggers a passive flow of water into the cell down its osmotic gradient, effectively increasing turgor pressure and causing the cell to depolarize.[100] Gagliano hypothesizes that the basis of associative learning in Pisum sativum is the coupling of mechanosensory and photosensory pathways and is mediated by auxin signaling pathways. The result is directional growth to maximize a plant's capture of sunlight.[32]

Gagliano et al. published another paper on habituation behaviors in the mimosa pudica plant whereby the innate behavior of the plant was diminished by repeated exposure to a stimulus.[18] There has been controversy around this paper and more generally around the topic of plant cognition. Charles Abrahmson, a psychologist and behavioral biologist, says that part of the issue of why scientists disagree about whether plants have the ability to learn is that researchers do not use a consistent definition of "learning" and "cognition".[101] Similarly, Michael Pollan, an author, and journalist, says in his piece The Intelligent Plant that researchers do not doubt Gagliano's data but rather her language, specifically her use of the term "learning" and "cognition" with respect to plants.[102] A direction for future research is testing whether circadian rhythms in plants modulate learning and behavior and surveying researchers' definitions of "cognition" and "learning".

Machine learning

[edit]
Robots can learn to cooperate.

Machine learning, a branch of artificial intelligence, concerns the construction and study of systems that can learn from data. For example, a machine learning system could be trained on email messages to learn to distinguish between spam and non-spam messages. Most of the Machine Learning models are based on probabilistic theories where each input (e.g. an image ) is associated with a probability to become the desired output.

Types

[edit]

Phases

[edit]

See also

[edit]
  • 21st century skills – Skills identified as being required for success in the 21st century
  • Anticipatory socialization – Process in which people take on the values of groups that they aspire to join
  • Epistemology – Philosophical study of knowledge
  • Implicit learning – in learning psychology
  • Instructional theory – Theory that offers explicit guidance on how to better help people learn and develop
  • Learning sciences – Critical theory of learning
  • Lifelong learning – Ongoing, voluntary, and self-motivated pursuit of knowledge
  • Living educational theory
  • Media psychology – Area of psychology
  • Subgoal labeling – Cognitive process

Information theory

[edit]
  • Algorithmic information theory – Subfield of information theory and computer science
  • Algorithmic probability – mathematical method of assigning a prior probability to a given observation
  • Bayesian inference – Method of statistical inference
  • Inductive logic programming – learning logic programs from data
  • Inductive probability – Determining the probability of future events based on past events
  • Information theory – Scientific study of digital information
  • Minimum description length – Model selection principle
  • Minimum message length – Formal information theory restatement of Occam's Razor
  • Occam's razor – Philosophical problem-solving principle
  • Solomonoff's theory of inductive inference – A mathematical theory
  • AIXI – Mathematical formalism for artificial general intelligence

Types of education

[edit]
  • Autodidacticism – Independent education without the guidance of teachers
  • Andragogy – Methods and principles in adult education
  • Pedagogy – Theory and practice of education

References

[edit]
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Notes

[edit]
  • Mayer, R.E. (2001). Multimedia learning. New York: Cambridge University Press. ISBN 978-0-521-78749-9.
  • Paivio, A. (1971). Imagery and verbal processes. New York: Holt, Rinehart, and Winston. ISBN 978-0-03-085173-5.

Further reading

[edit]
  • Ulrich Boser (2019). Learn Better: Mastering the Skills for Success in Life, Business, and School, or How to Become an Expert in Just About Anything. Rodale Books. ISBN 978-0593135310.
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  • How People Learn: Brain, Mind, Experience, and School (expanded edition) published by the National Academies Press
  • Applying Science of Learning in Education: Infusing Psychological Science into the Curriculum published by the American Psychological Association

 

Frequently Asked Questions

End-Stage Renal Disease (ESRD) is the final stage of chronic kidney disease where the kidneys no longer function adequately. Risk adjustment models are crucial in medical coding for ESRD because they ensure appropriate reimbursement by accounting for the severity and complexity of patients conditions, leading to fair compensation and resource allocation.
These models impact healthcare providers financially by adjusting payment rates based on patient health status, ensuring that providers who treat sicker or more complex patients receive higher reimbursements, thus incentivizing quality care without financial loss from treating high-risk populations.
Data elements commonly used include demographic information (age, gender), clinical factors (comorbidities, previous hospitalizations), treatment modalities (dialysis type), and lab results. These factors help predict healthcare costs and resources needed for individual patients accurately.
Comorbidities significantly influence ESRD risk adjustment scores as they reflect additional health challenges a patient faces. The presence of multiple or severe comorbidities increases the risk score, signaling higher expected care costs and justifying increased reimbursement rates to cover these expenses.
Accurate medical coding plays a critical role as it ensures that all relevant patient data is captured correctly. This accuracy directly affects the reliability of risk adjustments, leading to appropriate reimbursement levels. Misreporting can result in underfunded care or financial penalties for overcoding.