Evidence map›Paper›PMID 27422733›Full record

ReviewBMC health services research2016

Effective health care for older people living and dying in care homes: a realist review.

Claire Goodman, Tom Dening, Adam L Gordon, Susan L Davies, Julienne Meyer, Finbarr C Martin, John R F Gladman, Clive Bowman, Christina Victor, Melanie Handley and 3 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in BMC health services research, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 5 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Claire GoodmanCentre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, AL10 9AB, UK. c.goodman@herts.ac.uk.ORCID 0000-0002-8938-4893
Tom DeningInstitute of Mental Health, University of Nottingham, Nottingham, UK.
Adam L GordonDivision of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK.
Susan L DaviesCentre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, AL10 9AB, UK.
Julienne MeyerSchool of Health Sciences, City University, London, UK.
Finbarr C MartinDivision of Health and Social Care Research, Kings College London, London, UK.
John R F GladmanDivision of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK.
Clive BowmanSchool of Health Sciences, City University, London, UK.
Christina VictorDepartment of Community Health Nursing and Health Studies, Brunel University, Uxbridge, UK.
Melanie HandleyCentre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, AL10 9AB, UK.
Heather GageSchool of Economics, University of Surrey, Guildford, UK.
Steve IliffeDepartment of Primary Care & Population Health, University College London, London, UK.
Maria ZubairSchool of Sociology and Social Policy & Centre for Dementia, Institute of Mental Health, University of Nottingham, Nottingham, UK.

Funding

Department of Health 11/1021/02
6 · The paper itself

Abstract

backgroundCare 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.

methodsWe 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.

resultsStrategies 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.

conclusionHow 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.

Indexed as

Homes for the AgedQuality of Health CareTerminal CareAgedEnglandGeriatric NursingHealth Services AccessibilityHumansNational Health ProgramsPatient Care PlanningCare homeHealth outcomesLong-term careOlder peopleRealist review

Identifiers

PMID27422733
PMCPMC4947336

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.