Effective health care for older people resident in care homes: The Optimal study protocol for realist review

Claire Goodman, Adam L Gordon, Finbarr Martin , Susan Davies, Steve Iliffe, Clive Bowman, Justine Schneider, Julienne Meyer, Christina Victor, Heather Gage, John Gladman, Tom Dening

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
155 Downloads (Pure)


Background: Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is
highly variable in both quantity and quality. This variability is also evident in the commissioning and organisation of care home-specific services that range from the payment of incentives to general practitioners (GPs) to visit care homes, to the creation of care home specialist teams and outreach services run by geriatricians. No primary studies or systematic reviews have robustly evaluated the impact of these different approaches on organisation and resident-level outcomes. Our aim is to identify factors which may explain the perceived or demonstrated effectiveness of programmes to improve health-related outcomes in older people living in care homes.
Methods/Design: A realist review approach will be used to develop a theoretical understanding of what works when, why and in what circumstances. Elements of service models of interest include those that focus on assessment and management of residents’ health, those that use strategies to
encourage closer working between visiting health care providers and care home staff, and
those that address system-wide issues about access to assessment and treatment. These will
include studies on continence, dignity, and speech and language assessment as well as
interventions to promote person centred dementia care, improve strength and mobility, and
nutrition. The impact of these interventions and their different mechanisms will be considered
in relation to five key outcomes: residents’ medication use, use of out of hours’ services,
hospital admissions (including use of Accident and Emergency) and length of hospital stay,
costs and user satisfaction. An iterative three-stage approach will be undertaken that is
stakeholder-driven and optimises the knowledge and networks of the research team.
Discussion: This realist review will explore why and for whom different approaches to providing health
care to residents in care homes improves access to health care in the five areas of interest. It
will inform commissioning decisions and be the basis for further research. This systematic
review protocol is registered on the PROSPERO database reference number:
Original languageEnglish
Article number49
Pages (from-to)7
JournalSystematic reviews
Publication statusPublished - 24 May 2014


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