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Optimal healthcare delivery to care homes in the UK: a realist evaluation of what supports effective working to improve healthcare outcomes

Gordon, Adam L.; Goodman, Claire; Davies, Sue L.; Dening, Tom; Gage, Heather; Meyer, Julienne; Schneider, Justine; Bell, Brian; Jordan, Jake; Martin, Finbarr C.; Iliffe, Steve; Bowman, Clive; Gladman, John R.F.; Victor, Christina; Mayrhofer, Andrea; Handley, Melanie; Zubair, Maria


Professor of The Care of Older People

Claire Goodman

Sue L. Davies

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Clinical Professor in Dementia Research

Heather Gage

Julienne Meyer

Professor of Mental Health & Social Care

Jake Jordan

Finbarr C. Martin

Steve Iliffe

Clive Bowman

John R.F. Gladman

Christina Victor

Andrea Mayrhofer

Melanie Handley

Maria Zubair


Introduction: care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use.

Methods: a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners.

Results: context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which ‘wraps around’ care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites.

Conclusion: activities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise.


Gordon, A. L., Goodman, C., Davies, S. L., Dening, T., Gage, H., Meyer, J., …Zubair, M. (2018). Optimal healthcare delivery to care homes in the UK: a realist evaluation of what supports effective working to improve healthcare outcomes. Age and Ageing, 47(4), 595-603.

Journal Article Type Article
Acceptance Date Nov 20, 2017
Online Publication Date Jul 1, 2018
Publication Date Jan 5, 2018
Deposit Date Jan 11, 2018
Publicly Available Date Jan 11, 2018
Journal Age and Ageing
Print ISSN 0002-0729
Electronic ISSN 1468-2834
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 47
Issue 4
Pages 595-603
Keywords nursing homes; homes for the aged; health services for the aged; primary care; older people
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