Optimal healthcare delivery to care homes in the UK: a realist evaluation of what supports effective working to improve healthcare outcomes

Adam Gordon , Claire Goodman, Sue L Davies, Tom Dening , Heather Gage, Julienne Meyer, Justine Schneider, Brian Bell , Jake Jordan , Finbarr Martin , Steve Iliffe , Clive Bowman, John Gladman, Christina Victor, Andrea Mayrhofer, Melanie Handley, Maria Zubair

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)
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Introduction: care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. Methods: a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners. Results: context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which 'wraps around' care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites. Conclusion: activities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise.

Original languageEnglish
Pages (from-to)595–603
Number of pages9
JournalAge and Ageing
Issue number4
Early online date5 Jan 2018
Publication statusPublished - 1 Jul 2018


  • Health services for the aged
  • Homes for the aged
  • Nursing homes
  • Older people
  • Primary care


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