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Effective health care for older people resident in care homes: the optimal study protocol for realist review

Goodman, Claire; Gordon, Adam L.; Martin, Finbarr; Davies, Sue L.; Iliffe, Steve; Bowman, Clive; Schneider, Justine; Meyer, Julienne; Victor, Christina; Gage, Heather; Gladman, John R.F.; Dening, Tom

Authors

Claire Goodman

ADAM GORDON Adam.Gordon@nottingham.ac.uk
Professor of The Care of Older People

Finbarr Martin

Sue L. Davies

Steve Iliffe

Clive Bowman

JUSTINE SCHNEIDER justine.schneider@nottingham.ac.uk
Professor of Mental Health & Social Care

Julienne Meyer

Christina Victor

Heather Gage

JOHN GLADMAN john.gladman@nottingham.ac.uk
Professor of Medicine of Older People

TOM DENING Tom.Dening@nottingham.ac.uk
Clinical Professor in Dementia Research



Abstract

Background
Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is highly variable in both quantity and quality. This variability is also evident in the commissioning and organisation of care home-specific services that range from the payment of incentives to general practitioners (GPs) to visit care homes, to the creation of care home specialist teams and outreach services run by geriatricians. No primary studies or systematic reviews have robustly evaluated the impact of these different approaches on organisation and resident-level outcomes. Our aim is to identify factors which may explain the perceived or demonstrated effectiveness of programmes to improve health-related outcomes in older people living in care homes.

Methods/Design
A realist review approach will be used to develop a theoretical understanding of what works when, why and in what circumstances. Elements of service models of interest include those that focus on assessment and management of residents’ health, those that use strategies to encourage closer working between visiting health care providers and care home staff, and those that address system-wide issues about access to assessment and treatment. These will include studies on continence, dignity, and speech and language assessment as well as interventions to promote person centred dementia care, improve strength and mobility, and nutrition. The impact of these interventions and their different mechanisms will be considered in relation to five key outcomes: residents’ medication use, use of out of hours’ services, hospital admissions (including use of Accident and Emergency) and length of hospital stay, costs and user satisfaction. An iterative three-stage approach will be undertaken that is stakeholder-driven and optimises the knowledge and networks of the research team.

Discussion
This realist review will explore why and for whom different approaches to providing health care to residents in care homes improves access to health care in the five areas of interest. It will inform commissioning decisions and be the basis for further research. This systematic review protocol is registered on the PROSPERO database reference number: CRD42014009112.

Citation

Goodman, C., Gordon, A. L., Martin, F., Davies, S. L., Iliffe, S., Bowman, C., …Dening, T. (2014). Effective health care for older people resident in care homes: the optimal study protocol for realist review. Systematic Reviews, 3(1), https://doi.org/10.1186/2046-4053-3-49

Journal Article Type Article
Acceptance Date May 14, 2014
Publication Date May 24, 2014
Deposit Date Feb 28, 2017
Publicly Available Date Feb 28, 2017
Journal Systematic Reviews
Electronic ISSN 2046-4053
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 3
Issue 1
Article Number 49
DOI https://doi.org/10.1186/2046-4053-3-49
Keywords Residential facilities, Primary care, Older people, Health services, Realist review
Public URL http://eprints.nottingham.ac.uk/id/eprint/40876
Publisher URL http://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-3-49
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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