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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 and Zubair, Maria (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). pp. 595-603.

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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.

Item Type: Article
Divisions : Faculty of Arts and Social Sciences > School of Economics
Authors :
Gordon, Adam L
Goodman, Claire
Davies, Sue L
Dening, Tom
Meyer, Julienne
Schneider, Justine
Bell, Brian
Martin, Finbarr C
Iliffe, Steve
Bowman, Clive
Gladman, John R F
Victor, Christina
Mayrhofer, Andrea
Handley, Melanie
Zubair, Maria
Date : 5 January 2018
DOI : 10.1093/ageing/afx195
Copyright Disclaimer : © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non- Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
Uncontrolled Keywords : Nursing homes; Homes for the aged; Health services for the aged; Primary care; Older people
Depositing User : Clive Harris
Date Deposited : 08 Jan 2018 15:11
Last Modified : 13 Jul 2018 08:33

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