title: The effect of using high facilitation when implementing the Gold Standards Framework in Care Homes programme: a cluster randomised controlled trial.
abstract: BACKGROUND
  The provision of quality end-of-life care is increasingly on the national agenda in many countries. In the United Kingdom, the Gold Standards Framework for Care Homes programme has been promoted as a national framework for improving end-of-life care. While its implementation is recommended, there are no national guidelines for facilitators to follow to undertake this role.
  
  
  OBJECTIVE
  It was hypothesised that action learning alongside high facilitation when implementing the Gold Standards Framework for Care Homes programme will result in a reduced proportion of hospital deaths for residents and improvement in the care home staff ability to facilitate good end-of-life care.
  
  
  METHODS
  A cluster randomised controlled trial where 24 nursing homes received high facilitation to enable them to implement the Gold Standards Framework for Care Homes programme. The managers of 12 nursing homes additionally took part in action learning sets. A third group (14 nursing homes) received the 'standard' Gold Standards Framework for Care Homes facilitation available in their locality.
  
  
  METHODS
  In total, 38 nursing homes providing care for frail older people, their deceased residents and their nurse managers.
  
  
  RESULTS
  A greater proportion of residents died in those nursing homes receiving high facilitation and action learning but not significantly so. There was a significant association between the level of facilitation and nursing homes completing the Gold Standards Framework for Care Homes programme through to accreditation. Year-on-year change occurred across all outcome measures.
  
  
  CONCLUSIONS
  There is a danger that without national guidelines, facilitation of the Gold Standards Framework for Care Homes programme will vary and consequently so will its implementation. The nurse manager of a care home must be actively engaged when implementing the Gold Standards Framework for Care Homes programme.
authors.affiliation: Care Home Project Team, St Christopher's Hospice, London, UK j.kinley@stchristophers.org.uk.
authors.forename: Julie
authors.initials: J
authors.lastname: Kinley
authors.affiliation: Care Home Project Team, St Christopher's Hospice, London, UK.
authors.forename: Louisa
authors.initials: L
authors.lastname: Stone
authors.affiliation: Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Dewey
authors.affiliation: Lancaster University, Lancaster, UK.
authors.forename: Jean
authors.initials: J
authors.lastname: Levy
authors.affiliation: Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Stewart
authors.affiliation: Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.affiliation: Care Home Project Team, St Christopher's Hospice, London, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Sykes
authors.affiliation: Care Home Project Team, St Christopher's Hospice, London, UK.
authors.forename: Penny
authors.initials: P
authors.lastname: Hansford
authors.affiliation: Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Aysha
authors.initials: A
authors.lastname: Begum
authors.affiliation: Care Home Project Team, St Christopher's Hospice, London, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Hockley
mesh_terms: D019091:Critical Pathways / Q000458:organization & administration; D004739:England; D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D013727:Terminal Care / Q000458:organization & administration* / Q000592:standards
keywords: Gold Standards Framework in Care Homes; cluster randomised controlled trial; end-of-life care; facilitation; nursing homes