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dc.contributor.authorChadborn, Neil H
dc.contributor.authorGoodman, Claire
dc.contributor.authorZubair, Maria
dc.contributor.authorSousa, Lídia
dc.contributor.authorGladman, John R F
dc.contributor.authorDening, Tom
dc.contributor.authorGordon, Adam L
dc.date.accessioned2019-04-26T14:05:26Z
dc.date.available2019-04-26T14:05:26Z
dc.date.issued2019-04-08
dc.identifier.citationChadborn , N H , Goodman , C , Zubair , M , Sousa , L , Gladman , J R F , Dening , T & Gordon , A L 2019 , ' Role of comprehensive geriatric assessment in healthcare of older people in UK care homes : realist review ' , BMJ Open , vol. 9 , no. 4 , e026921 . https://doi.org/10.1136/bmjopen-2018-026921
dc.identifier.issn2044-6055
dc.identifier.otherPURE: 16644930
dc.identifier.otherPURE UUID: 011c03bc-75d5-40fa-8791-38e90fd9247e
dc.identifier.otherPubMed: 30962238
dc.identifier.otherScopus: 85064383830
dc.identifier.urihttp://hdl.handle.net/2299/21305
dc.description© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
dc.description.abstractOBJECTIVES: Comprehensive geriatric assessment (CGA) may be a way to deliver optimal care for care home residents. We used realist review to develop a theory-driven account of how CGA works in care homes. DESIGN: Realist review. SETTING: Care homes. METHODS: The review had three stages: first, interviews with expert stakeholders and scoping of the literature to develop programme theories for CGA; second, iterative searches with structured retrieval and extraction of the literature; third, synthesis to refine the programme theory of how CGA works in care homes.We used the following databases: Medline, CINAHL, Scopus, PsychInfo, PubMed, Google Scholar, Greylit, Cochrane Library and Joanna Briggs Institute. RESULTS: 130 articles informed a programme theory which suggested CGA had three main components: structured comprehensive assessment, developing a care plan and working towards patient-centred goals. Each of these required engagement of a multidisciplinary team (MDT). Most evidence was available around assessment, with tension between structured assessment led by a single professional and less structured assessment involving multiple members of an MDT. Care planning needed to accommodate visiting clinicians and there was evidence that a core MDT often used care planning as a mechanism to seek external specialist support. Goal-setting processes were not always sufficiently patient-centred and did not always accommodate the views of care home staff. Studies reported improved outcomes from CGA affecting resident satisfaction, prescribing, healthcare resource use and objective measures of quality of care. CONCLUSION: The programme theory described here provides a framework for understanding how CGA could be effective in care homes. It will be of use to teams developing, implementing or auditing CGA in care homes. All three components are required to make CGA work-this may explain why attempts to implement CGA by interventions focused solely on assessment or care planning have failed in some long-term care settings. TRIAL REGISTRATION NUMBER: CRD42017062601.en
dc.format.extent9
dc.language.isoeng
dc.relation.ispartofBMJ Open
dc.subjectcare homes
dc.subjectcare planning
dc.subjectcomprehensive geriatric assessment
dc.subjectgeriatric medicine
dc.subjectmultidisciplinary
dc.subjectquality in health care
dc.subjectMedicine(all)
dc.titleRole of comprehensive geriatric assessment in healthcare of older people in UK care homes : realist reviewen
dc.contributor.institutionSchool of Health and Social Work
dc.contributor.institutionCentre for Research in Public Health and Community Care
dc.description.statusPeer reviewed
dc.identifier.urlhttp://www.scopus.com/inward/record.url?scp=85064383830&partnerID=8YFLogxK
rioxxterms.versionVoR
rioxxterms.versionofrecordhttps://doi.org/10.1136/bmjopen-2018-026921
rioxxterms.typeJournal Article/Review
herts.preservation.rarelyaccessedtrue


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