Long-Term Care Around the Globe
The Optimal Study: Describing the Key Components of Optimal Health Care Delivery to UK Care Home Residents: A Research Protocol

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Abstract

Long-term institutional care in the United Kingdom is provided by care homes. Residents have prevalent cognitive impairment and disability, have multiple diagnoses, and are subject to polypharmacy. Prevailing models of health care provision (ad hoc, reactive, and coordinated by general practitioners) result in unacceptable variability of care. A number of innovative responses to improve health care for care homes have been commissioned. The organization of health and social care in the United Kingdom is such that it is unlikely that a single solution to the problem of providing quality health care for care homes will be identified that can be used nationwide. Realist evaluation is a methodology that uses both qualitative and quantitative data to establish an in-depth understanding of what works, for whom, and in what settings. In this article we describe a protocol for using realist evaluation to understand the context, mechanisms, and outcomes that shape effective health care delivery to care home residents in the United Kingdom. By describing this novel approach, we hope to inform international discourse about research methodologies in long-term care settings internationally.

Section snippets

Methods

The study takes a 2-phase design, both using realist evaluation methodology.13 Phase 1, described elsewhere,14 is a hypothesis-generating workstream designed to describe the range of health service delivery models for care homes within the United Kingdom and to propose what features of these might be “active ingredients” associated with positive outcomes for residents. It is conducting a synthesis of surveys of service provision in UK care homes, interviews with national and regional

Conclusion

The organization and day-to-day running of long-term care facilities differs significantly between countries although resident cohorts are very similar in terms of the types of care they require.12 This has more to do with historical and political factors than with the optimal configuration for care delivery. One consequence of this has been that, despite the growing number of research studies conducted in long-term care, international collaborative studies have been less common.23

If

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    The authors declare no conflicts of interest.

    The Optimal Study is independent research commissioned through the National Institute of Health Research Health Service and Delivery Programme (HS&DR 11/1021/02). The views expressed in this presentation are those of the author(s) and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health. The study has received ethical approval from the UK Social Research Ethics Committee, reference number 13/IEC08/0048.

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