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Relationships, expertise, incentives, and governance: supporting care home residents' access to health care. An interview study from England.

Abstract：

OBJECTIVES:To explore what commissioners of care, regulators, providers, and care home residents in England identify as the key mechanisms or components of different service delivery models that support the provision of National Health Service (NHS) provision to independent care homes. METHODS:Qualitative, semistructured interviews with a purposive sample of people with direct experience of commissioning, providing, and regulating health care provision in care homes and care home residents. Data from interviews were augmented by a secondary analysis of previous interviews with care home residents on their personal experience of and priorities for access to health care. Analysis was framed by the assumptions of realist evaluation and drew on the constant comparative method to identify key themes about what is required to achieve quality health care provision to care homes and resident health. RESULTS:Participants identified 3 overlapping approaches to the provision of NHS that they believed supported access to health care for older people in care homes: (1) Investment in relational working that fostered continuity and shared learning between visiting NHS staff and care home staff, (2) the provision of age-appropriate clinical services, and (3) governance arrangements that used contractual and financial incentives to specify a minimum service that care homes should receive. CONCLUSION:The 3 approaches, and how they were typified as working, provide a rich picture of the stakeholder perspectives and the underlying assumptions about how service delivery models should work with care homes. The findings inform how evidence on effective working in care homes will be interrogated to identify how different approaches, or specifically key elements of those approaches, achieve different health-related outcomes in different situations for residents and associated health and social care organizations.

journal_name

J Am Med Dir Assoc

journal_title

Journal of the American Medical Directors Association

authors

Goodman C,Davies SL,Gordon AL,Meyer J,Dening T,Gladman JR,Iliffe S,Zubair M,Bowman C,Victor C,Martin FC

doi

10.1016/j.jamda.2015.01.072

subject

Has Abstract

pub_date

2015-05-01 00:00:00

pages

427-32

issue

eissn

1525-8610

issn

1538-9375

pii

S1525-8610(15)00073-0

journal_volume

pub_type

杂志文章

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Relationships, expertise, incentives, and governance: supporting care home residents' access to health care. An interview study from England.