This study will explore whether and how Comprehensive Geriatric Assessment (CGA) works for older people living in care homes and whether and how it can be implemented using the Quality Improvement Collaborative Approach.
Comprehensive Geriatric Assessment (CGA) describes a model of health care which is based upon comprehensive multidisciplinary assessment taking account of medical, psychological, functional, social and environmental problems. It then institutes individualised management plans which are case managed by an appropriately skilled health professional. It can improve the health and wellbeing of older patients with frailty. It has not yet been implemented at scale and pace across the care home sector, where many of the most frail members of our population live.
Quality Improvement Collaboratives are an approach widely used in healthcare settings around the globe to bring professionals together around a shared improvement goal to drive up standards for care recipients. They have not previously been used in the UK care home sector.
The study started with a realist review of how CGA works in long-term care home settings. This drew on findings from 130 published articles alongsie interviews and focus groups with expert practitioners to understand the ways in which delivery of CGA in care homes is similar to, and differs from, how it is delivered in other settings.
We then recruited staff from care homes and NHS organisations across South Nottinghamshire to work in Quality Improvement Collaboratives to implement CGA in care homes within their geographic location. They were supported by experts in care of older people, quality improvement and health informatics. They developed locality specific approaches to improve care in care homes. By keeping detailed fieldnotes, alongside interviews and focus groups, we built a detailed understanding of how Quality Improvement Collaboratives work at the interface between health and social care.
As part of this process we developed novel approaches to identifying care home residents in hospital databases and used these findings to develop a care-home NHS service use dashboard which could be used together by NHS and care home staff to understand how changes to care influence NHS service use.
Zubair M, Chadborn N, Gladman JR, Dening T, Gordon AL, Goodman C. 2017. Using Comprehensive Geriatric Assessment for Quality Improvements in Healthcare of Older People in UK Care Homes: protocol for realist review within Proactive Healthcare of Older People in Care Homes (PEACH) study. BMJ Open. 7(10)
Housley G, Lewis S, Usman A, Gordon AL, Shaw DE. 2018. Accurate identification of hospital admissions from care homes: development and validation of an automated algorithm. Age and Ageing, 47(3): 387-391
Devi R, Meyer J, Banerjee J, Goodman C, Gladman JRF, Dening T, Chadborn N, Hinsliff-Smith K, Long A, Usman AM, Housley G, Bowman C, Martin F, Logan P, Lewis S, Gordon AL. 2018. A Quality Improvement Collaborative Aiming for Proactive HEAlthcare of Older People in Care Homes (PEACH): a realist evaluation protocol. BMJ Open. 8 (11).
Usman A, Lewis S, Hinsliff-Smith K, Long A, Housley G, Jordan J, Gage H, Dening T, Gladman JRF, Gordon AL. 2018. Measuring health related quality of life of care home residents, comparison of self-report with staff proxy responses for EQ-5D-5L and HowRu: Protocol for Assessing Proxy Reliability In Care home Outcome Testing. BMJ Open. 8 (8).
Usman A, Lewis S, Jordan J, Gage H, Devi R, Housley G, Hinsliff-Smith K, Long A, Chadborn N, Dening T, Gladman JRG, Gordon AL. Statistical Analysis Plan for the Proactive Healthcare of Older People Living in Care Homes (PEACH) Study. EMRAN Discussion Paper Series. Issue 22. Available online at: https://www.nottingham.ac.uk/emran/documents/issue-22-emran-sep-2018.pdf
Usman A, Lewis S, Hinsliff-Smith K, Long A, Housley G, Jordan J, Gage H, Dening T, Gladman JRF, Gordon AL. Measuring health related quality of life of care home residents: comparison of self-report with staff proxy responses. Age and Ageing, available via online advance access at: https://academic.oup.com/ageing/advance-rticle/doi/10.1093/ageing/afy191/5274649?searchresult=1
Chadborn N, Goodman C, Zubair M, Sousa L, Gladman JRF, Dening T, Gordon AL. The Role of Comprehensive Geriatric Assessment in Older People in UK Care Homes: A Realist Review. BMJ Open, in press.