The Optimal Study: Describing the Key Components of Optimal Health Care Delivery to UK Care Home Residents: A Research Protocol

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

doi:10.1016/j.jamda.2014.06.011

Cited by 11 publications

(9 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These observations are consistent with epidemiological studies conducted in our setting, which confirm that the prevalence of IOP in end-of-life transitions is above 50%, with 70% of cases suffering from advanced dementia [17,18]. As mentioned previously [19], to improve IOP care, it is necessary to develop integrated care proposals from social and health care perspectives [20,21]. This was, in fact, one of the motivations to develop the new "Integrated medical care model for institutionalized older people" in our region, the objective of which is to improve the duration and continuity of care of these people.…”

Section: Discussionsupporting

confidence: 93%

What Lies Beneath: Clinical and Resource-use Characteristics of Institutionalized Older People. A Retrospective, Population-based Cohort Study in Catalonia

Amblàs-Novellas

Santaeugènia

Vela

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundPlanning population care in a specific health care setting requires deep knowledge of the clinical characteristics of the target care recipients, which tend to be country specific. Our area virtually lacks any descriptive, far-reaching publications about institutionalized older people (IOP). We aimed to investigate the demographic and clinical characteristics of institutionalized older people (IOP) ≥65 years old and compare them with those of the rest of the population of the same age.MethodsRetrospective analysis (total cohort approach) of clinical and resource-use characteristics of IOP and non-IOP older than 65 years in Catalonia (North-East Spain). Variables analysed included age and sex, diagnoses, morbidity burden—using Adjusted Morbidity Groups (GMA)—, mortality, use of resources, and medications taken. All data were obtained from the administrative database of the local healthcare system.ResultsThis study included 93,038, 78,458, 68,545 and 67,456 IOP from 2011, 2013, 2015 and 2017, respectively. In this interval, an increase in mean age (82.02 vs. 85.95 years), in women (68.64% vs. 72.11%) and in annual mortality (11.74% vs. 20.46%) was observed. Compared with non-IOP (p<0.001 in all comparisons), IOP showed a higher annual mortality (20.46% vs. 3.13%), a larger number of chronic diseases (specially dementia: 46.47% vs. 4.58%), higher multimorbidity (15.2% vs. 4.2% with GMA of maximum complexity), and annual admissions to acute care (47.6% vs. 27.7%) and skilled nursing facilities (27.8% vs. 7.4%), mean length of hospital stay (10.0 vs. 7.2 days) and mean of medications taken (11.7 vs. 8.0). ConclusionsThere is a growing gap between the clinical and demographic characteristics of age-matched IOP and non-IOP, which overlaps with a higher mortality rate of IOP. The profile of resources utilization of IOP compared with non-IOP strongly suggests a deficiency of preventive actions and stresses the need to rethink the care model for IOP from a social and health care perspective.

show abstract

Section: Discussionsupporting

confidence: 93%

What Lies Beneath: Clinical and Resource-use Characteristics of Institutionalized Older People. A Retrospective, Population-based Cohort Study in Catalonia

Amblàs-Novellas

Santaeugènia

Vela

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Details of the protocol are published elsewhere. 56 The chapter is divided into two sections. The first section describes the case study sites, recruitment and participant details.…”

Section: Resultsmentioning

confidence: 99%

Optimal NHS service delivery to care homes: a realist evaluation of the features and mechanisms that support effective working for the continuing care of older people in residential settings

Goodman

Davies

Gordon

et al. 2017

Health Serv Deliv Res

Self Cite

View full text Add to dashboard Cite

Background: Care homes are the institutional providers of long-term care for older people. The OPTIMAL\ud study argued that it is probable that there are key activities within different models of health-care provision\ud that are important for residents’ health care.

\ud \ud \ud

Objectives: To understand ‘what works, for whom, why and in what circumstances?’. Study questions\ud focused on how different mechanisms within the various models of service delivery act as the ‘active\ud ingredients’ associated with positive health-related outcomes for care home residents.

\ud \ud \ud

Methods: Using realist methods we focused on five outcomes: (1) medication use and review; (2) use of\ud out-of-hours services; (3) hospital admissions, including emergency department attendances and length of\ud hospital stay; (4) resource use; and (5) user satisfaction. Phase 1: interviewed stakeholders and reviewed\ud the evidence to develop an explanatory theory of what supported good health-care provision for further\ud testing in phase 2. Phase 2 developed a minimum data set of resident characteristics and tracked their care\ud for 12 months. We also interviewed residents, family and staff receiving and providing health care to residents.\ud The 12 study care homes were located on the south coast, the Midlands and the east of England. Health-care\ud provision to care homes was distinctive in each site.

\ud \ud \ud

Findings: Phase 1 found that health-care provision to care homes is reactive and inequitable. The realist\ud review argued that incentives or sanctions, agreed protocols, clinical expertise and structured approaches to\ud assessment and care planning could support improved health-related outcomes; however, to achieve change NHS professionals and care home staff needed to work together from the outset to identify, co-design and\ud implement agreed approaches to health care. Phase 2 tested this further and found that, although there\ud were few differences between the sites in residents’ use of resources, the differences in service integration\ud between the NHS and care homes did reflect how these institutions approached activities that supported\ud relational working. Key to this was how much time NHS staff and care home staff had had to learn how to\ud work together and if the work was seen as legitimate, requiring ongoing investment by commissioners\ud and engagement from practitioners. Residents appreciated the general practitioner (GP) input and, when\ud supported by other care home-specific NHS services, GPs reported that it was sustainable and valued work.\ud Access to dementia expertise, ongoing training and support was essential to ensure that both NHS and care\ud home staff were equipped to provide appropriate care.

\ud \ud \ud

Limitations: Findings were constrained by the numbers of residents recruited and retained in phase 2 for\ud the 12 months of data collection.

\ud \ud \ud

Conclusions: NHS services work well with care homes when payments and role specification endorse the\ud im...

show abstract

“…The realist synthesis will be focussed on the most relevant strategies that would be needed to be used in the medicine management intervention developed. Developing initial programme theory: a programme theory sets out how and why outcomes occur within an intervention [23, 26]. …”

Section: Methodsmentioning

confidence: 99%

“…Developing initial programme theory: a programme theory sets out how and why outcomes occur within an intervention [23, 26]. …”

Section: Methodsmentioning

confidence: 99%

Developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)––a realist synthesis

et al. 2017

View full text Add to dashboard Cite

BackgroundMedication-related adverse events have been estimated to be responsible for 5700 deaths and cost the UK £750 million annually. This burden falls disproportionately on older people. Outcomes from interventions to optimise medication management are caused by multiple context-sensitive mechanisms. The MEdication Management in Older people: REalist Approaches BAsed on Literature and Evaluation (MEMORABLE) project uses realist synthesis to understand how, why, for whom and in what context interventions, to improve medication management in older people on complex medication regimes residing in the community, work.MethodThis realist synthesis uses secondary data and primary data from interviews to develop the programme theory. A realist logic of analysis will synthesise data both within and across the two data sources to inform the design of a complex intervention(s) to help improve medication management in older people.Literature reviewThe review (using realist synthesis) contains five stages to develop an initial programme theory to understand why processes are more or less successful and under which situations: focussing of the research question; developing the initial programme theory; developing the search strategy; selection and appraisal based on relevance and rigour; and data analysis/synthesis to develop and refine the programme theory and context, intervention and mechanism configurations.Realist interviewsRealist interviews will explore and refine our understanding of the programme theory developed from the realist synthesis. Up to 30 older people and their informal carers (15 older people with multi-morbidity, 10 informal carers and 5 older people with dementia), and 20 care staff will be interviewed.Developing framework for the intervention(s)Data from the realist synthesis and interviews will be used to refine the programme theory for the intervention(s) to identify: the mechanisms that need to be ‘triggered’, and the contexts related to these mechanisms. Intervention strategies that change the contexts so the mechanisms are triggered to produce desired outcomes will be developed. Feedback on these strategies will be obtained. DiscussionThis realist synthesis aims to develop a framework (underpinned by our programme theory) for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens.Systematic review registrationPROSPERO CRD42016043506Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0528-1) contains supplementary material, which is available to authorized users.

show abstract

The Optimal Study: Describing the Key Components of Optimal Health Care Delivery to UK Care Home Residents: A Research Protocol

Cited by 11 publications

References 22 publications

What Lies Beneath: Clinical and Resource-use Characteristics of Institutionalized Older People. A Retrospective, Population-based Cohort Study in Catalonia

What Lies Beneath: Clinical and Resource-use Characteristics of Institutionalized Older People. A Retrospective, Population-based Cohort Study in Catalonia

Optimal NHS service delivery to care homes: a realist evaluation of the features and mechanisms that support effective working for the continuing care of older people in residential settings

Developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)––a realist synthesis

Contact Info

Product

Resources

About