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How quality improvement collaboratives work to improve healthcare in care homes: a realist evaluation
- Authors:
- DEVI Reena, et al
- Journal article citation:
- Age and Ageing, 50(4), 2021, pp.1371-1381.
- Publisher:
- Oxford University Press
Background: Quality improvement collaboratives (QICs) bring together multidisciplinary teams in a structured process to improve care quality. How QICs can be used to support healthcare improvement in care homes is not fully understood. Methods: A realist evaluation to develop and test a programme theory of how QICs work to improve healthcare in care homes. A multiple case study design considered implementation across 4 sites and 29 care homes. Observations, interviews and focus groups captured contexts and mechanisms operating within QICs. Data analysis classified emerging themes using context-mechanism-outcome configurations to explain how NHS and care home staff work together to design and implement improvement. Results: QICs will be able to implement and iterate improvements in care homes where they have a broad and easily understandable remit; recruit staff with established partnership working between the NHS and care homes; use strategies to build relationships and minimise hierarchy; protect and pay for staff time; enable staff to implement improvements aligned with existing work; help members develop plans in manageable chunks through QI coaching; encourage QIC members to recruit multidisciplinary support through existing networks; facilitate meetings in care homes and use shared learning events to build multidisciplinary interventions stepwise. Teams did not use measurement for change, citing difficulties integrating this into pre-existing and QI-related workload. Conclusions: These findings outline what needs to be in place for health and social care staff to work together to effect change. Further research needs to consider ways to work alongside staff to incorporate measurement for change into QI. (Edited publisher abstract)
What works in delivering effective enhanced primary care support in care homes?
- Author:
- CORDIS BRIGHT
- Publisher:
- Cordis Bright
- Publication year:
- 2018
- Pagination:
- 12
- Place of publication:
- London
Based on a review of the evidence, this briefing outlines the key elements to effective practice in delivering enhanced primary care and support in care homes to improve the quality of life and healthcare for residents. The briefing identifies some of the reasons for implementing enhanced primary care in care homes and the potential to improve outcomes. These include improved resident and care quality outcomes; beneficial impact on secondary care and community services; improved integration and partnership working; and cost benefits. It also outlines key supportive features and the barriers and limitations to delivering enhanced primary care in care homes. Three short case studies highlight three different models: a nurse-led model, a GP-led model, and a multi-disciplinary team model. (Edited publisher abstract)
Linking GPs with care homes: Harrogate and Rural District Clinical Commissioning Group
- Authors:
- NHS CONFEDERATION, HARROGATE AND RURAL DISTRICT CLINICAL COMMISSIONING GROUP
- Publisher:
- NHS Confederation
- Publication year:
- 2016
- Pagination:
- 2
- Place of publication:
- London
Case study which describes a scheme introduced by Harrogate and Rural District Clinical Commissioning Group (CCG) to link each of the 17 GP practices in the area to a local care home. The scheme was introduced in response to the fact that local care home residents had twice the number of GP visits as other patients of a similar age and that GPs had a small number of care home patients across a large number of facilities. Both GPs and care homes have provided positive feedback on the scheme and a 4 per cent reduction in emergency admissions for care home residents has been recorded. (Edited publisher abstract)
The interface between primary care and care homes: General Practitioner experiences of working in care homes for older people
- Authors:
- WHITE Caroline, ALTON Elisabeth
- Journal article citation:
- Health and Social Care in the Community, early cite January 2022,
- Publisher:
- Wiley
Supporting residents in care homes for older people is an important, though little studied, aspect of the General Practitioner (GP) role. This study explored GPs’ experiences of working to support older people living in care homes, and the challenges and facilitators to providing effective care in this unique practice environment. A qualitative online survey was shared with GPs in England via Twitter and through Named Doctor for Safeguarding networks. This was available from October 2019–March 2020 and was completed by 58 GPs. Responses were analysed using inductive Thematic Analysis. Participants highlighted the complexity of care home residents’ health, with multiple long-term conditions frequently reported. Furthermore, dementia and communication difficulties meant the GPs were often reliant on communication with others (staff and families). GPs had to navigate multiple relationships within care homes, including with residents, staff/managers, families and other healthcare practitioners, all of whom could have competing perspectives and priorities. Gaining access to information about resident health could be challenging, and was affected by staff continuity/discontinuity; lack of Wi-Fi access was also common. Care home organisation of and support for the visit was important. This paper concludes that care home work requires GP skills to meet resident healthcare needs, as well as to navigate multiple relationships. GPs are often reliant on others; this has important implications, both risking marginalising the resident voice, and in respect of recognising and reporting abuse. (Edited publisher abstract)
Enhanced Health in Care Homes: a guide for care homes
- Author:
- CARE PROVIDER ALLIANCE
- Publisher:
- Care Provider Alliance
- Publication year:
- 2021
- Pagination:
- 22
The NHS Long Term Plan contained a commitment to roll out the Framework for Enhanced Health in Care Homes (V2) across England between 2020 and 2024. This document explains what the Enhanced Health in Care Homes (EHCH) programme is, how to make it work in the best way possible for people living in care homes and the people who care for them, and what everyone involved can expect from it. Contents include: aligning care homes to Primary Care Networks (PCNs); the Enhanced Health in Care Homes (EHCH) service; the PCN clinical lead role; the multi-disciplinary team (MDT); and capturing and sharing information. This guide is intended for Registered Managers of care homes and care home staff in England but may be of interest to a wider group, including health care professionals. (Edited publisher abstract)
Oral health for adults in care homes: NG48
- Author:
- NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE
- Publisher:
- National Institute for Health and Care Excellence
- Publication year:
- 2016
- Place of publication:
- London
Practice guidance covering oral health, including dental health and daily mouth care, for adults in care homes. The guideline includes recommendations on improving and maintaining residents’ day-to-day oral healthcare, ensuring staff are properly trained to confidently look after the oral health needs of residents, and ensuring there is adequate access to dental services when needed. It also recommends all residents have an oral health assessment when they enter a care home with the results being entered into their personal care plan. Recommendations are provided for care home managers, care staff, health and wellbeing boards, dental practitioners and oral health promotion teams. (Edited publisher abstract)
Quality of chronic disease care for older people in care homes and the community in a primary care pay for performance system: retrospective study
- Authors:
- SHAH Sunil M., et al
- Journal article citation:
- British Medical Journal, 12.3.11, 2011, p.587.
- Publisher:
- British Medical Association
Using Retrospective analysis of the Health Improvement Network (THIN), a large primary care database, this study describes the quality of care for chronic diseases among older people in care homes compared with the community in a pay for performance system (the Quality and Outcomes Framework). Participants were 10,387 residents of care homes and 403,259 residents in the community aged 65 to 104 and registered for 90 or more days with their general practitioner. A total of 326 English and Welsh general practices were included. After adjustment for age, sex, dementia, and length of registration, attainment of quality indicators was significantly lower for residents of care homes than for those in the community for 14 of 16 indicators. Attainment was lower in nursing homes than in residential homes. The study concludes that there is scope for improving the management of chronic diseases in care homes, but high attainment of some indicators shows that pay for performance systems do not invariably disadvantage residents of care homes compared with those living in the community. High use of exception reporting may compromise care for vulnerable patient groups.
Postcode tariff: PCTs and GP retainers in care homes
- Author:
- PATTERSON Maria
- Publisher:
- English Community Care Association
- Publication year:
- 2010
- Pagination:
- 21p.
- Place of publication:
- London
This report is a follow up report to the 2008 report by the English Community Care Association 'Can we afford the doctor?' on the issue of care homes being charged retainer fees by GPs to visit and register care home residents. This new report examines the levels of awareness of primary care trusts (PCTs) of the issue, and PCT attitudes towards GP retainers. In particular, it investigates PCTs’ views on the practice of GPs charging care homes simply for registering and visiting residents. The views were obtained using a brief online survey contained five close-ended questions which received 29 responses from PCT Chief Executives. The results demonstrate the fact that access to GP services varies according to location. The report also presents some examples of good practice working between primary care services and care homes, with the intention of promoting such practice and demonstrating that positive and proactive partnerships between GP practices and care homes are possible and achievable. Recommendations are provided to PCT services regarding the payment of retainer fees by care homes to GPs.
Association between subjective memory complaints and nursing home placement: a four-year follow-up
- Authors:
- BOCH WALDORFF Frans, SIERSMA Volkert, WALDEMAR Gunhild
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(6), June 2009, pp.602-609.
- Publisher:
- Wiley
In order to evaluate whether elderly persons with subjective memory complaints may be regarded as a group of potentially vulnerable patients who need close follow-up, the authors investigated the risk of nursing home placement during a 4-year follow-up period. A prospective cohort survey was carried out. Cox proportional hazard models were used to examine the influence of risk factors on nursing home placement. Results showed that a total of 758 non-nursing home residents aged 65 years and older consulted the General Practitioners in October and November 2002, of whom 50 nursing home placements were observed. Subjective memory complaints were associated with an adjusted Hazard Ratio (HR) of 2.59 for nursing home placement. Other statistical significant covariates were MMSE < 24 (HR = 3.95), age and extreme anxiety/depression. The effect of subjective memory complaints is seen to moderate when subjects are older. The authors conclude that the data of this study indicated that in an elderly primary care population the presence of subjective memory complaints was a significant independent predictor for nursing home placement together with other known risk factors.
Partnership working by default: district nurses and care home staff providing care for older people
- Authors:
- GOODMAN Claire, et al
- Journal article citation:
- Health and Social Care in the Community, 13(6), November 2005, pp.553-562.
- Publisher:
- Wiley
This paper describes two consecutive studies completed in 2001 and 2003 that involved focus groups and survey methods of enquiry conducted in two settings: an England shire and inner London. The research questions that both studies had in common were (1) What is the contribution of district nursing and other primary care services to care homes that do not have on-site nursing provision? (2) What strategies promote participation and collaboration between residents, care home staff and NHS primary care nursing staff? and (3) What are the current obstacles and aids to effective partnership working and learning? A total of 74 community-based nurses and care home managers and staff took part in 10 focus groups, while 124 care home managers (73% of the 171 surveyed) and 113 district nurse team leaders (80% of the 142 surveyed) participated in the surveys. Findings from both studies demonstrated that nurses were the most frequent NHS professional visiting care homes. Although care home managers and district nurses believed that they had a good working relationship, they had differing expectations of what the nursing contribution should be and how personal and nursing care were defined. This influenced the range of services that older people had access to and the amount of training and support care home staff received from district nurses and the extent to which they were able to develop collaborative and reciprocal patterns of working. Findings indicate that there is a need for community-based nursing services to adopt a more strategic approach that ensures older people in care homes can access the services they are entitled to and receive equivalent health care to older people who live in their own homes.