University of Hertfordshire

From the same journal

By the same authors


  • Maria Zubair
  • Neil H Chadborn
  • John Gladman
  • Tom Dening
  • Adam Gordon
  • Claire Goodman
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Original languageEnglish
Article numbere017270
JournalBMJ Open
Publication statusPublished - 1 Oct 2017


Introduction Care home residents are relatively high
users of healthcare resources and may have complex
needs. Comprehensive geriatric assessment (CGA) may
benefit care home residents and improve efficiency of
care delivery. This is an approach to care in which there
is a thorough multidisciplinary assessment (physical
and mental health, functioning and physical and social
environments) and a care plan based on this assessment,
usually delivered by a multidisciplinary team. The CGA
process is known to improve outcomes for communitydwelling
older people and those in receipt of hospital
care, but less is known about its efficacy in care home
Methods and analysis Realist review was selected as
the most appropriate method to explore the complex
nature of the care home setting and multidisciplinary
delivery of care. The aim of the realist review is to identify
and characterise a programme theory that underpins the
CGA intervention. The realist review will extract data from
research articles which describe the causal mechanisms
through which the practice of CGA generates outcomes.
The focus of the intervention is care homes, and the
outcomes of interest are health-related quality of life and
satisfaction with services; for both residents and staff.
Further outcomes may include appropriate use of National
Health Service services and resources of older care home
residents. The review will proceed through three stages:
(1) identifying the candidate programme theories that
underpin CGA through interviews of key stakeholder,
systematic search of the peer-reviewed and non-peerreviewed
evidence, (2) identifying the evidence relevant
to CGA in UK care homes and refining the programme
theories through refining and iterating the systematic
search, lateral searches and seeking further information
from study authors and (3) analysis and synthesis of
evidence, involving the testing of the programme theories.
Ethics and dissemination The PEACH project was
identified as service development following submission
to the UK Health Research Authority and subsequent
review by the University of Nottingham Research Ethics
Committee. The study protocols have been reviewed
as part of good governance by the Nottinghamshire
Healthcare Foundation Trust. We aim to publish this realist
review in a peer-reviewed journal with international
readership. We will disseminate findings to public and
stakeholders using knowledge mobilisation techniques.
Stakeholders will include the Quality Improvement
Collaboratives within PEACH study. National networks,
such as British Society of Gerontology and National Care
Association will be approached for wider dissemination.
Trial registration number The realist review has been
registered on International Prospective Register of
Systematic Reviews (PROSPERO 2017: CRD42017062601).


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