title: The optimal study: describing the key components of optimal health care delivery to UK care home residents: a research protocol.
abstract: Long-term institutional care in the United Kingdom is provided by care homes. Residents have prevalent cognitive impairment and disability, have multiple diagnoses, and are subject to polypharmacy. Prevailing models of health care provision (ad hoc, reactive, and coordinated by general practitioners) result in unacceptable variability of care. A number of innovative responses to improve health care for care homes have been commissioned. The organization of health and social care in the United Kingdom is such that it is unlikely that a single solution to the problem of providing quality health care for care homes will be identified that can be used nationwide. Realist evaluation is a methodology that uses both qualitative and quantitative data to establish an in-depth understanding of what works, for whom, and in what settings. In this article we describe a protocol for using realist evaluation to understand the context, mechanisms, and outcomes that shape effective health care delivery to care home residents in the United Kingdom. By describing this novel approach, we hope to inform international discourse about research methodologies in long-term care settings internationally.
authors.affiliation: Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK. Electronic address: adam.gordon@nottingham.ac.uk.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Gordon
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Goodman
authors.affiliation: Institute of Mental Health, University of Nottingham, Nottingham, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Dening
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Davies
authors.affiliation: Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK.
authors.forename: John R F
authors.initials: JR
authors.lastname: Gladman
authors.affiliation: Division of Primary Care, University of Nottingham, Nottingham, UK.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Bell
authors.affiliation: Institute of Mental Health, University of Nottingham, Nottingham, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Zubair
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Handley
authors.affiliation: School of Health Sciences, City University, London, UK.
authors.forename: Julienne
authors.initials: J
authors.lastname: Meyer
authors.affiliation: School of Health Sciences, City University, London, UK.
authors.forename: Clive
authors.initials: C
authors.lastname: Bowman
authors.affiliation: School of Economics, University of Surrey, Guildford, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Gage
authors.affiliation: Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Steve R
authors.initials: SR
authors.lastname: Iliffe
authors.affiliation: Division of Health and Social Care Research, Kings College London, London, UK.
authors.forename: Finbarr C
authors.initials: FC
authors.lastname: Martin
authors.affiliation: Institute of Mental Health, University of Nottingham, Nottingham, UK.
authors.forename: Justine
authors.initials: J
authors.lastname: Schneider
authors.affiliation: Department of Community Health Nursing and Health Studies, Brunel University, London, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Victor
mesh_terms: D003695:Delivery of Health Care / Q000639:trends*; D006707:Homes for the Aged / Q000639:trends*; D006801:Humans; D009735:Nursing Homes / Q000639:trends*; D009936:Organizational Innovation; D011787:Quality of Health Care; D013222:State Medicine; D006113:United Kingdom
keywords: Nursing homes; delivery of health care; frail older adults; homes for the aged; research design