title: Relationships, expertise, incentives, and governance: supporting care home residents' access to health care. An interview study from England.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK. Electronic address: c.goodman@herts.ac.uk.
authors: Claire
authors: C
authors: Goodman
authors: Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK.
authors: Sue L
authors: SL
authors: Davies
authors: Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK.
authors: Adam L
authors: AL
authors: Gordon
authors: School of Health Sciences, City University, London, UK.
authors: Julienne
authors: J
authors: Meyer
authors: Centre for Dementia, Institute of Mental Health, University of Nottingham, Nottingham, UK.
authors: Tom
authors: T
authors: Dening
authors: Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK.
authors: John R F
authors: JR
authors: Gladman
authors: Department of Primary Care and Population Health, University College London, London, UK.
authors: Steve
authors: S
authors: Iliffe
authors: Centre for Dementia, Institute of Mental Health, University of Nottingham, Nottingham, UK; School of Sociology and Social Policy, University of Nottingham, Nottingham, UK.
authors: Maria
authors: M
authors: Zubair
authors: School of Health Sciences, City University, London, UK.
authors: Clive
authors: C
authors: Bowman
authors: Department of Community Health Nursing and Health Studies, Brunel University, London, UK.
authors: Christina
authors: C
authors: Victor
authors: Division of Health and Social Care Research, Kings College London, London, UK.
authors: Finbarr C
authors: FC
authors: Martin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004739:England; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006299:Health Services for the Aged / Q000458:organization & administration*; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration
keywords: Care homes; frailty; health care; health services; older people; realist review