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Role of comprehensive geriatric assessment in healthcare of older people in UK care homes : realist review. / Chadborn, Neil H; Goodman, Claire; Zubair, Maria; Sousa, Lídia; Gladman, John R F; Dening, Tom; Gordon, Adam L.

In: BMJ Open, Vol. 9, No. 4, e026921, 08.04.2019.

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APA

Chadborn, N. H., Goodman, C., Zubair, M., Sousa, L., Gladman, J. R. F., Dening, T., & Gordon, A. L. (2019). Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review. BMJ Open, 9(4), [e026921]. https://doi.org/10.1136/bmjopen-2018-026921

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Chadborn, Neil H ; Goodman, Claire ; Zubair, Maria ; Sousa, Lídia ; Gladman, John R F ; Dening, Tom ; Gordon, Adam L. / Role of comprehensive geriatric assessment in healthcare of older people in UK care homes : realist review. In: BMJ Open. 2019 ; Vol. 9, No. 4.

Bibtex

@article{011c03bc75d540fa879138e90fd9247e,
title = "Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review",
abstract = "OBJECTIVES: Comprehensive geriatric assessment (CGA) may be a way to deliver optimal care for care home residents. We used realist review to develop a theory-driven account of how CGA works in care homes.DESIGN: Realist review.SETTING: Care homes.METHODS: The review had three stages: first, interviews with expert stakeholders and scoping of the literature to develop programme theories for CGA; second, iterative searches with structured retrieval and extraction of the literature; third, synthesis to refine the programme theory of how CGA works in care homes.We used the following databases: Medline, CINAHL, Scopus, PsychInfo, PubMed, Google Scholar, Greylit, Cochrane Library and Joanna Briggs Institute.RESULTS: 130 articles informed a programme theory which suggested CGA had three main components: structured comprehensive assessment, developing a care plan and working towards patient-centred goals. Each of these required engagement of a multidisciplinary team (MDT). Most evidence was available around assessment, with tension between structured assessment led by a single professional and less structured assessment involving multiple members of an MDT. Care planning needed to accommodate visiting clinicians and there was evidence that a core MDT often used care planning as a mechanism to seek external specialist support. Goal-setting processes were not always sufficiently patient-centred and did not always accommodate the views of care home staff. Studies reported improved outcomes from CGA affecting resident satisfaction, prescribing, healthcare resource use and objective measures of quality of care.CONCLUSION: The programme theory described here provides a framework for understanding how CGA could be effective in care homes. It will be of use to teams developing, implementing or auditing CGA in care homes. All three components are required to make CGA work-this may explain why attempts to implement CGA by interventions focused solely on assessment or care planning have failed in some long-term care settings.TRIAL REGISTRATION NUMBER: CRD42017062601.",
keywords = "care homes, care planning, comprehensive geriatric assessment, geriatric medicine, multidisciplinary, quality in health care",
author = "Chadborn, {Neil H} and Claire Goodman and Maria Zubair and L{\'i}dia Sousa and Gladman, {John R F} and Tom Dening and Gordon, {Adam L}",
note = "{\circledC} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.",
year = "2019",
month = "4",
day = "8",
doi = "10.1136/bmjopen-2018-026921",
language = "English",
volume = "9",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "4",

}

RIS

TY - JOUR

T1 - Role of comprehensive geriatric assessment in healthcare of older people in UK care homes

T2 - realist review

AU - Chadborn, Neil H

AU - Goodman, Claire

AU - Zubair, Maria

AU - Sousa, Lídia

AU - Gladman, John R F

AU - Dening, Tom

AU - Gordon, Adam L

N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

PY - 2019/4/8

Y1 - 2019/4/8

N2 - OBJECTIVES: Comprehensive geriatric assessment (CGA) may be a way to deliver optimal care for care home residents. We used realist review to develop a theory-driven account of how CGA works in care homes.DESIGN: Realist review.SETTING: Care homes.METHODS: The review had three stages: first, interviews with expert stakeholders and scoping of the literature to develop programme theories for CGA; second, iterative searches with structured retrieval and extraction of the literature; third, synthesis to refine the programme theory of how CGA works in care homes.We used the following databases: Medline, CINAHL, Scopus, PsychInfo, PubMed, Google Scholar, Greylit, Cochrane Library and Joanna Briggs Institute.RESULTS: 130 articles informed a programme theory which suggested CGA had three main components: structured comprehensive assessment, developing a care plan and working towards patient-centred goals. Each of these required engagement of a multidisciplinary team (MDT). Most evidence was available around assessment, with tension between structured assessment led by a single professional and less structured assessment involving multiple members of an MDT. Care planning needed to accommodate visiting clinicians and there was evidence that a core MDT often used care planning as a mechanism to seek external specialist support. Goal-setting processes were not always sufficiently patient-centred and did not always accommodate the views of care home staff. Studies reported improved outcomes from CGA affecting resident satisfaction, prescribing, healthcare resource use and objective measures of quality of care.CONCLUSION: The programme theory described here provides a framework for understanding how CGA could be effective in care homes. It will be of use to teams developing, implementing or auditing CGA in care homes. All three components are required to make CGA work-this may explain why attempts to implement CGA by interventions focused solely on assessment or care planning have failed in some long-term care settings.TRIAL REGISTRATION NUMBER: CRD42017062601.

AB - OBJECTIVES: Comprehensive geriatric assessment (CGA) may be a way to deliver optimal care for care home residents. We used realist review to develop a theory-driven account of how CGA works in care homes.DESIGN: Realist review.SETTING: Care homes.METHODS: The review had three stages: first, interviews with expert stakeholders and scoping of the literature to develop programme theories for CGA; second, iterative searches with structured retrieval and extraction of the literature; third, synthesis to refine the programme theory of how CGA works in care homes.We used the following databases: Medline, CINAHL, Scopus, PsychInfo, PubMed, Google Scholar, Greylit, Cochrane Library and Joanna Briggs Institute.RESULTS: 130 articles informed a programme theory which suggested CGA had three main components: structured comprehensive assessment, developing a care plan and working towards patient-centred goals. Each of these required engagement of a multidisciplinary team (MDT). Most evidence was available around assessment, with tension between structured assessment led by a single professional and less structured assessment involving multiple members of an MDT. Care planning needed to accommodate visiting clinicians and there was evidence that a core MDT often used care planning as a mechanism to seek external specialist support. Goal-setting processes were not always sufficiently patient-centred and did not always accommodate the views of care home staff. Studies reported improved outcomes from CGA affecting resident satisfaction, prescribing, healthcare resource use and objective measures of quality of care.CONCLUSION: The programme theory described here provides a framework for understanding how CGA could be effective in care homes. It will be of use to teams developing, implementing or auditing CGA in care homes. All three components are required to make CGA work-this may explain why attempts to implement CGA by interventions focused solely on assessment or care planning have failed in some long-term care settings.TRIAL REGISTRATION NUMBER: CRD42017062601.

KW - care homes

KW - care planning

KW - comprehensive geriatric assessment

KW - geriatric medicine

KW - multidisciplinary

KW - quality in health care

UR - http://www.scopus.com/inward/record.url?scp=85064383830&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2018-026921

DO - 10.1136/bmjopen-2018-026921

M3 - Article

VL - 9

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 4

M1 - e026921

ER -