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Goodman, Claire; Dening, Tom; Gordon, Adam L.; Davies, Susan L.; Meyer, Julienne; Martin, Finbarr C.; Gladman, John R.F.; Bowman, Clive; Victor, Christina; Handley, Melanie; Gage, Heather; Iliffe, Steve; Zubair, Maria (2016)
Publisher: BIOMED Central
Journal: BMC Health Services Research
Languages: English
Types: Article
Subjects: Realist review, Health outcomes, Care home, Research Article, Health Policy, Long-term care, Older people
Background: Care home residents in England have variable access to health care services. There is currently no coherent policy or consensus about the best arrangements to meet these needs. The purpose of this review was to explore the evidence for how different service delivery models for care home residents support and/or improve wellbeing and health-related outcomes in older people living and dying in care homes. Methods: We conceptualised models of health care provision to care homes as complex interventions. We used a realist review approach to develop a preliminary understanding of what supported good health care provision to care homes. We completed a scoping of the literature and interviewed National Health Service and Local Authority commissioners, providers of services to care homes, representatives from the Regulator, care home managers, residents and their families. We used these data to develop theoretical propositions to be tested in the literature to explain why an intervention may be effective in some situations and not others. We searched electronic databases and related grey literature. Finally the findings were reviewed with an external advisory group. Results: Strategies that support and sustain relational working between care home staff and visiting health care professionals explained the observed differences in how health care interventions were accepted and embedded into care home practice. Actions that encouraged visiting health care professionals and care home staff jointly to identify, plan and implement care home appropriate protocols for care, when supported by ongoing facilitation from visiting clinicians, were important. Contextual factors such as financial incentives or sanctions, agreed protocols, clinical expertise and structured approaches to assessment and care planning could support relational working to occur, but of themselves appeared insufficient to achieve change. Conclusion: How relational working is structured between health and care home staff is key to whether health service interventions achieve health related outcomes for residents and their respective organisations. The belief that either paying clinicians to do more in care homes and/or investing in training of care home staff is sufficient for better outcomes was not supported. This research was funded by National Institute of Health Research Health Service Delivery and Research programme (HSDR 11/021/02).
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    • 1. Buisson L. Care of elderly people : UK market survey 2013. London: Laing & Buisson; 2013.
    • 2. Gordon AL, et al. Health status of UK care home residents: a cohort study. Age Ageing. 2014;43(1):97-103.
    • 3. Bowman C, Meyer J. Formative Care: Defining the purpose and clinical practice of care for the frail. J R Soc Med. 2014;107(3):95-8.
    • 4. Iliffe S, et al. Provision of NHS generalist and specialist services to care homes in England: review of surveys. Prim Health Care Res Dev. 2015; FirstView: p. 1-16.
    • 5. BGS. Quest for Quality: A joint working party inquiry into the quality of healthcare support for older people in care homes. London: British Geriatrics Society; 2011.
    • 6. Davies SL, et al. A systematic review of integrated working between care homes and health care services. BMC Health Serv Res. 2011;11:320.
    • 7. Hancock GA, et al. The needs of older people with dementia in residential care. Int J Geriatr Psychiatry. 2006;21(1):43-9.
    • 8. Glendinning C, et al. A survey of access to medical services in nursing and residential homes in England. Br J Gen Pract. 2002;52(480):545-8.
    • 9. Mann AH, et al. Depression and the response of residential homes to physical health needs. Int J Geriatr Psychiatry. 2000;15(12):1105-12.
    • 10. Goodman C, et al. Collaborating with primary care: promoting shared working between district nurses and care home staff. Understanding care homes: a research and development perspective. London: Jessica Kingsley Publishers; 2009. p. 201-22.
    • 11. Szczepura A, Nelson S, Wild D. In-reach specialist nursing teams for residential care homes: uptake of services, impact on care provision and cost-effectiveness. BMC Health Serv Res. 2008;8:269.
    • 12. Pawson R, Wong G, Owen L. Known knowns, known unknowns, unknown unknowns: the predicament of evidence-based policy. Am J Eval. 2011: p. 1098214011403831.
    • 13. Wong G, et al. RAMESES publication standards: realist syntheses. BMC Med. 2013;11:21.
    • 14. Pawson R. Evidence-based policy : a realist perspective. London: Sage; 2006.
    • 15. Pawson R, et al. Realist synthesis: an introduction. ESRC Research Methods Programme. Manchester: University of Manchester; 2004.
    • 16. Goodman C, et al. Relationships, Expertise, Incentives, and Governance: Supporting Care Home Residents' Access to Health Care. An Interview Study From England. J Am Med Dir Assoc. 2015;16(5):427-32.
    • 17. Jackson SF, Kolla G. A New Realistic Evaluation Analysis Method Linked Coding of Context, Mechanism, and Outcome Relationships. Am J Eval. 2012;33(3):339-49.
    • 18. Clegg A, et al. Frailty in elderly people. Lancet. 2013;381(9868):752-62.
    • 19. Stuck AE, et al. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA. 2002;287(8):1022-8.
    • 20. Doran T, et al. Effect of financial incentives on incentivised and nonincentivised clinical activities: longitudinal analysis of data from the UK Quality and Outcomes Framework. BMJ. 2011;342:d3590.
    • 21. Berta W, et al. Spanning the know-do gap: understanding knowledge application and capacity in long-term care homes. Soc Sci Med. 2010;70(9): 1326-34.
    • 22. Toles M, Anderson RA. State of the science: relationship-oriented management practices in nursing homes. Nurs Outlook. 2011;59(4):221-7.
    • 23. Gordon AL, et al. A systematic mapping review of Randomized Controlled Trials (RCTs) in care homes. BMC Geriatr. 2012;12(1):1.
    • 24. Rycroft-Malone J, et al. Realist synthesis: illustrating the method for implementation research. Implement Sci. 2012;7:33.
    • 25. Pearson M, et al. Providing effective and preferred care closer to home: a realist review of intermediate care. Health Soc Care Community. 2015:1; 23(6):577-93.
    • 26. Chenoweth L, et al. Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial. Lancet Neurol. 2009;8(4):317-25.
    • 27. Mannion R, Davies H. Payment for performance in health care. Br Med J. 2008;7639:306.
    • 28. McDonald R, et al. Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study. BMJ. 2007; 334(7608):1357.
    • 29. Doran T, et al. Effect of financial incentives on inequalities in the delivery of primary clinical care in England: analysis of clinical activity indicators for the quality and outcomes framework. Lancet. 2008;372(9640):728-36.
    • 30. Roland M, Paddison C. Better management of patients with multimorbidity. BMJ. 2013;346:f2510.
    • 31. Szczepura A, Wild D, Nelson S. Medication administration errors for older people in long-term residential care. BMC Geriatr. 2011;11(1):82.
    • 32. Barber ND, et al. Care homes use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people. Qual Saf Health Care. 2009;18:348-55.
    • 33. Shah SM, et al. Quality of prescribing in care homes and the community in England and Wales. Br J Gen Pract. 2012;62(598):e329-36.
    • 34. Witter S, et al. Paying for performance to improve the delivery of health interventions in low-and middle-income countries. Cochrane Database Syst Rev. 2012;2(2):CD007899.
    • 35. Charlesworth A, Hawkins L, Marshall L. NHS payment reform: lessons from the past and directions for the future. London: Nuffield Trust; 2014.
    • 36. Shah SM, et al. Quality of chronic disease care for older people in care homes and the community in a primary care pay for performance system: retrospective study. BMJ. 2011;342:d912.
    • 37. Russell G. Does paying for performance in primary care save lives? BMJ. 2015;350:h1051.
    • 38. Evans G. Factors influencing emergency hospital admissions from nursing and residential homes: positive results from a practice‐based audit. J Eval Clin Pract. 2011;17(6):1045-9.
    • 39. Fossey J, et al. Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial. BMJ. 2006;332(7544):756-61.
    • 40. Loganathan M, et al. Interventions to optimise prescribing in care homes: systematic review. Age Ageing. 2011;40(2):150-62.
    • 41. Stuck AE, et al. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993;342(8878):1032-6.
    • 42. Ellis G, et al. Comprehensive geriatric assessment for older adults admitted to hospital. BMJ. 2011;7:CD006211.
    • 43. Beswick AD, et al. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet. 2008;371:725-35.
    • 44. Gladman J, et al. Medical Crises in Older People: cohort study of older people attending acute medical units, developmental work and randomised controlled trial of a specialist geriatric medical intervention for high-risk older people; cohort study of older people with mental health problems admitted to hospital, developmental work and randomised controlled trial of a specialist medical and mental health unit for general hospital patients with delirium and dementia; and cohort study of residents of care homes and interview study of health-care provision to residents of care homes. 2015
    • 45. Morrell CJ, et al. Identification of depressive disorder among older people in care homes-a feasibility study. Prim Health Care Res Dev. 2011;12(03):255-65.
    • 46. Lyne K, et al. Analysis of a care planning intervention for reducing depression in older people in residential care. Aging Ment Health. 2006; 10(4):394-403.
    • 47. Underwood M, et al. Exercise for depression in care home residents: A randomised controlled trial with cost-effectiveness analysis (OPERA). Lancet. 2013;381.
    • 48. Cox H, et al. Educating nursing home staff on fracture prevention: a cluster randomised trial. Age Ageing. 2008;37(2):167-72.
    • 49. Kenkmann A, et al. Health, wellbeing and nutritional status of older people living in UK care homes: an exploratory evaluation of changes in food and drink provision. BMC Geriatr. 2010;10:28.
    • 50. Bamford C, et al. Implementing nutrition guidelines for older people in residential care homes: a qualitative study using Normalization Process Theory. Implement Sci. 2012;7(1):106.
    • 51. Bunn F, et al. Comorbidity and dementia: a scoping review of the literature. BMC Med. 2014;12(1):1-15.
    • 52. Merrell J, et al. Addressing the nutritional needs of older people in residential care homes. Health Soc Care Community. 2012;20(2):208-15.
    • 53. Sackley C, et al. Cluster randomized pilot controlled trial of an occupational therapy intervention for residents with stroke in UK care homes. Stroke. 2006;37(9):2336-41.
    • 54. Forsetlund L, et al. Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials. BMC Geriatr. 2011;11(1):16.
    • 55. Livingston G, et al. Improving the end-of-life for people with dementia living in a care home: an intervention study. Int Psychogeriatr. 2013;25(11): 1849-58.
    • 56. Badger F, et al. An evaluation of the impact of the Gold Standards Framework on collaboration in end-of-life care in nursing homes. A qualitative and quantitative evaluation. Int J Nurs Stud. 2012;49(5):586-95.
    • 57. Hasson F, et al. The palliative care link nurse role in nursing homes: barriers and facilitators. J Adv Nurs. 2008;64(3):233-42.
    • 58. Sprakes K, Tyrer J. Improving wound and pressure area care in a nursing home. Nurs Stand. 2010;25(10):43.
    • 59. De Visschere LM, et al. An oral health care guideline for institutionalised older people. Gerodontology. 2011;28(4):307-10.
    • 60. Mozley C, et al. The Care Home Activity Project: Does introducing an occupational therapy programme reduce depression in care homes? Aging Ment Health. 2007;11(1):99-107.
    • 61. Schneider J, et al. Costs of occupational therapy in residential homes and its impact on service use. Aging Ment Health. 2007;11(1):108-14.
    • 62. Goodman C. Evaluation of the End of Life Care Train the Trainer (TTT) Education Model. 2014.
    • 63. Hayward AC, Watson J. Effectiveness of influenza vaccination of staff on morbidity, and mortality of residents of long term care facilities for the elderly. Vaccine. 2011;29(13):2357-8.
    • 64. Froggatt K, et al. A system lifeworld perspective on dying in long term care settings for older people: Contested states in contested places. Health Place. 2011;17(1):263-8.
    • 65. Dudman J, Meyer J. Understanding residential home issues to meet healthcare needs. Br J Community Nurs. 2012;17(9):434-8.
    • 66. Handley M, et al. Living and dying: responsibility for end‐of‐life care in care homes without on‐site nursing provision‐a prospective study. Health Soc Care Community. 2014;22(1):22-9.
    • 67. Masterson-Algar P, et al. Towards a programme theory for fidelity in the evaluation of complex interventions. J Eval Clin Pract. 2014;20(4):445-52.
    • 68. Cooperrider DL, Whitney DK. Appreciative inquiry: A positive revolution in change. Berrett-Koehler Publishers. 2005.
    • 69. Gittell JH, et al. Impact of relational coordination on job satisfaction and quality outcomes: a study of nursing homes. Hum Resour Manag J. 2008; 18(2):154-70.
    • 70. Robbins I, et al. Explaining the barriers to and tensions in delivering effective healthcare in UK care homes: a qualitative study. BMJ. 2013;3(7):e003178.
    • 71. Goodman C, et al. Preferences and priorities for ongoing and end-of-life care: a qualitative study of older people with dementia resident in care homes. Int J Nurs Stud. 2013;50(12):1639-47.
    • 72. Amador S, et al. Exploring resource use and associated costs in end-of-life care for older people with dementia in residential care homes. Int J Geriatr Psychiatry. 2014;29(7):758-66.
    • 73. Sackley CM, et al. Effects of a physiotherapy and occupational therapy intervention on mobility and activity in care home residents: a cluster randomised controlled trial. BMJ. 2009;339:b3123.
    • 74. Brooker DJ, Woolley RJ, Lee D. Enriching opportunities for people living with dementia in nursing homes: an evaluation of a multi-level activitybased model of care. Aging Ment Health. 2007;11(4):361-70.
    • 75. Mayrhofer A, Goodman C, Holman C. Establishing a community of practice for dementia champions (innovative practice). Dementia. 2015;14(2):259-66.
    • 76. Goodman C, et al. Can district nurses and care home staff improve bowel care for older people using a clinical benchmarking tool? Br J Community Nurs. 2013;18(12):580-8.
    • 77. Goodman C, Davies S, Dickinson A, Gage H, Froggatt K. A study to develop integrated working between primary health care services and care homes final report. NIHR Service Delivery and Organisation Programme. 2013
    • 78. Kinley J, et al. The effect of using high facilitation when implementing the Gold Standards Framework in Care Homes programme: A cluster randomised controlled trial. Palliat Med. 2014;28(9):1099-109.
    • 79. Bakerjian D, Zisberg A. Applying the Advancing Excellence in America's Nursing Homes Circle of Success to improving and sustaining quality. Geriatr Nurs. 2013;34(5):402-11.
    • 80. Kodner DL, Spreeuwenberg C. Integrated care: meaning, logic, applications, and implications-a discussion paper. Int J Integr Care. 2002;2(4).
    • 81. Masso M, McCarthy G, Kitson A. Mechanisms which help explain implementation of evidence-based practice in residential aged care facilities: A grounded theory study. Int J Nurs Stud. 2014;51(7):1014-26.
    • 82. Bolmsjö BB, et al. “It is meaningful; I feel that I can make a difference”-A qualitative study about GPs' experiences of work at nursing homes in Sweden. BMC Fam Pract. 2015;16(1):111.
    • 83. Lund S, Richardson A, May C. Barriers to Advance Care Planning at the End of Life: An Explanatory Systematic Review of Implementation Studies. PLoS One. 2015;10(2):e0116629.
    • 84. Shah S, et al. Antipsychotic prescribing to older people living in care homes and the community in England and Wales. Int J Geriatr Psychiatry. 2011;26(4):423-34.
    • 85. Kinley J, Hockley J. A baseline review of medication provided to older people in nursing care homes in the last month of life. Int J Palliat Nurs. 2010;16(5):216-23.
    • 86. Barnes L, et al. Making sure the residents get their tablets: medication administration in care homes for older people. J Adv Nurs. 2006;56(2):190-9.
    • 87. Gadsby R, et al. Prescribed medicines for elderly frail people with diabetes resident in nursing homes-issues of polypharmacy and medication costs. Diabet Med. 2012;29(1):136-9.
    • 88. Alldred DP, et al. Interventions to optimise prescribing for older people in care homes. Cochrane Database Syst Rev. 2013;2(2).
    • 89. Barnett K, et al. Prevalence and outcomes of use of potentially inappropriate medicines in older people: cohort study stratified by residence in nursing home or in the community. BMJ Qual Saf. 2011
    • 90. Hockley J, et al. The integrated implementation of two end-of-life care tools in nursing care homes in the UK: an in-depth evaluation. Palliat Med. 2010; 24(8):828-38.
    • 91. Ahearn D, et al. Improving end of life care for nursing home residents: an analysis of hospital mortality and readmission rates. Postgrad Med J. 2010; 86(1013):131-5.
    • 92. Badger F, et al. An evaluation of the implementation of a programme to improve end-of-life care in nursing homes. Palliat Med. 2009;23(6):502-11.
    • 93. Amador S, et al. Emergency ambulance service involvement with residential care homes in the support of older people with dementia: an observational study. BMC Geriatr. 2014;14(1):95.
    • 94. Seymour JE, Kumar A, Froggatt K. Do nursing homes for older people have the support they need to provide end-of-life care? A mixed methods enquiry in England. Palliat Med. 2011;25(2):125-38.
    • 95. Goodman C. Can clinical benchmarking improve bowel care in older people in care homes for older people Final report. Department of Health Nursing Quality Research Initiative. 2006
    • 96. Aspray TJ, et al. Low bone mineral density measurements in care home residents-a treatable cause of fractures. Age Ageing. 2006;35(1):37-41.
    • 97. De Visschere L, et al. Effect evaluation of a supervised versus non‐supervised implementation of an oral health care guideline in nursing homes: a cluster randomised controlled clinical trial. Gerodontology. 2012;29(2):e96-e106.
    • 98. Hayward AC, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ. 2006;333(7581):1241.
    • 99. Davidson S, et al. The feasibility of a GP led screening intervention for depression among nursing home residents. Int J Geriatr Psychiatry. 2006; 21(11):1026-30.
    • 100. Ellard DR, et al. Whole home exercise intervention for depression in older care home residents (the OPERA study): a process evaluation. BMC Med. 2014;12:1.
    • 101. Cooke V, et al. Minnesota's nursing facility performance-based incentive payment program: An innovative model for promoting care quality. The Gerontologist. 2010;50(4):556-63.
    • 102. McDermott C, et al. Hospital admissions from nursing homes: a qualitative study of GP decision making. Br J Gen Pract. 2012;62(601):e538-45.
    • 103. Ong A, et al. High mortality of older patients admitted to hospital from care homes and insight into potential interventions to reduce hospital admissions from care homes: the Norfolk experience. Arch Gerontol Geriatr. 2011;53(3):316-9.
    • 104. Lawrence V, Banerjee S. Improving care in care homes: a qualitative evaluation of the Croydon care home support team. Aging Ment Health. 2010;14(4):416-24.
    • 105. Foster SJ, et al. Aged Residential Care Health Utilisation Study (ARCHUS): a randomised controlled trial to reduce acute hospitalisations from residential aged care. BMC Geriatr. 2012;12(1):54.
    • 106. Doherty D, Davies S. Examining the impact of a specialist care homes support team. Nurs Stand. 2008;23(5):35-41.
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