Cornes Michelle, Whiteford Martin, Manthorpe Jill, Neale Joanne, Byng Richard, Hewett Nigel, Clark Michael, Kilmister Alan, Fuller James, Aldridge Robert, Tinelli Michela
Social Care Workforce Research Unit, King's College London, London, UK.
Health Services Research, University of Liverpool, Liverpool, UK.
Health Soc Care Community. 2018 May;26(3):e345-e359. doi: 10.1111/hsc.12474. Epub 2017 Jul 20.
This review presents a realist synthesis of "what works and why" in intermediate care for people who are homeless. The overall aim was to update an earlier synthesis of intermediate care by capturing new evidence from a recent UK government funding initiative (the "Homeless Hospital Discharge Fund"). The initiative made resources available to the charitable sector to enable partnership working with the National Health Service (NHS) in order to improve hospital discharge arrangements for people who are homeless. The synthesis adopted the RAMESES guidelines and reporting standards. Electronic searches were carried out for peer-reviewed articles published in English from 2000 to 2016. Local evaluations and the grey literature were also included. The inclusion criteria was that articles and reports should describe "interventions" that encompassed most of the key characteristics of intermediate care as previously defined in the academic literature. Searches yielded 47 articles and reports. Most of these originated in the UK or the USA and fell within the realist quality rating of "thick description". The synthesis involved using this new evidence to interrogate the utility of earlier programme theories. Overall, the results confirmed the importance of (i) collaborative care planning, (ii) reablement and (iii) integrated working as key to effective intermediate care delivery. However, the additional evidence drawn from the field of homelessness highlighted the potential for some theory refinements. First, that "psychologically informed" approaches to relationship building may be necessary to ensure that service users are meaningfully engaged in collaborative care planning and second, that integrated working could be managed differently so that people are not "handed over" at the point at which the intermediate care episode ends. This was theorised as key to ensuring that ongoing care arrangements do not break down and that gains are not lost to the person or the system vis-à-vis the prevention of readmission to hospital.
本综述对为无家可归者提供的中级护理中“什么有效及为何有效”进行了现实主义综合分析。总体目标是通过获取英国政府近期一项资助计划（“无家可归者医院出院基金”）的新证据，更新早期的中级护理综合分析。该计划为慈善部门提供资源，以便与国民医疗服务体系（NHS）开展合作，从而改善无家可归者的医院出院安排。该综合分析采用了RAMESES指南和报告标准。对2000年至2016年以英文发表的同行评审文章进行了电子检索。还纳入了本地评估和灰色文献。纳入标准是文章和报告应描述“干预措施”，这些干预措施涵盖学术文献中先前定义的中级护理的大多数关键特征。检索得到47篇文章和报告。其中大多数源自英国或美国，属于“详细描述”的现实主义质量评级。该综合分析涉及利用这些新证据来审视早期项目理论的效用。总体而言，结果证实了以下几点的重要性：（i）协作式护理规划，（ii）恢复能力，以及（iii）综合协作，这些是有效提供中级护理的关键。然而，从无家可归领域获取的额外证据凸显了一些理论细化的可能性。首先，建立关系时采用“心理知情”方法可能是必要的，以确保服务使用者切实参与协作式护理规划；其次，综合协作的管理方式可以有所不同，以便在中级护理阶段结束时人们不会被“移交”。理论上这是确保持续护理安排不会中断且个人或系统不会因预防再次住院而失去所获成果的关键。
