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Relationships, expertise, incentives, and governance: supporting care home residents' access to health care: an interview study from England

Goodman, Claire; Davies, Sue L.; Gordon, Adam L.; Meyer, Julienne; Dening, Tom; Gladman, John R.F.; Iliffe, Steve; Zubair, Maria; Bowman, Clive; Victor, Christina; Martin, Finbarr C.

Authors

Claire Goodman

Sue L. Davies

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

Julienne Meyer

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

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

Steve Iliffe

Maria Zubair

Clive Bowman

Christina Victor

Finbarr C. Martin



Abstract

Objectives
To explore what commissioners of care, regulators, providers, and care home residents in England identify as the key mechanisms or components of different service delivery models that support the provision of National Health Service (NHS) provision to independent care homes.

Methods
Qualitative, semistructured interviews with a purposive sample of people with direct experience of commissioning, providing, and regulating health care provision in care homes and care home residents. Data from interviews were augmented by a secondary analysis of previous interviews with care home residents on their personal experience of and priorities for access to health care. Analysis was framed by the assumptions of realist evaluation and drew on the constant comparative method to identify key themes about what is required to achieve quality health care provision to care homes and resident health.

Results
Participants identified 3 overlapping approaches to the provision of NHS that they believed supported access to health care for older people in care homes: (1) Investment in relational working that fostered continuity and shared learning between visiting NHS staff and care home staff, (2) the provision of age-appropriate clinical services, and (3) governance arrangements that used contractual and financial incentives to specify a minimum service that care homes should receive.

Conclusion
The 3 approaches, and how they were typified as working, provide a rich picture of the stakeholder perspectives and the underlying assumptions about how service delivery models should work with care homes. The findings inform how evidence on effective working in care homes will be interrogated to identify how different approaches, or specifically key elements of those approaches, achieve different health-related outcomes in different situations for residents and associated health and social care organizations.

Journal Article Type Article
Publication Date May 1, 2015
Journal Journal of the American Medical Directors Association
Print ISSN 1525-8610
Electronic ISSN 1538-9375
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 16
Issue 5
APA6 Citation Goodman, C., Davies, S. L., Gordon, A. L., Meyer, J., Dening, T., Gladman, J. R., …Martin, F. C. (2015). Relationships, expertise, incentives, and governance: supporting care home residents' access to health care: an interview study from England. Journal of the American Medical Directors Association, 16(5), https://doi.org/10.1016/j.jamda.2015.01.072
DOI https://doi.org/10.1016/j.jamda.2015.01.072
Keywords Care homes, older people, health services, frailty, health care, realist review
Publisher URL http://www.sciencedirect.com/science/article/pii/S1525861015000730
Related Public URLs http://www.jamda.com/article/S1525-8610(15)00073-0/abstract
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0

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Relationships, expertise, incentives and governance- supporting care home residents' access to health care.pdf (227 Kb)
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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0





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