Zubair Maria, Chadborn Neil H, Gladman John R F, Dening Tom, Gordon Adam L, Goodman Claire
Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK.
Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK.
BMJ Open. 2017 Oct 10;7(10):e017270. doi: 10.1136/bmjopen-2017-017270.
Care home residents are relatively high users of healthcare resources and may have complex needs. Comprehensive geriatric assessment (CGA) may benefit care home residents and improve efficiency of care delivery. This is an approach to care in which there is a thorough multidisciplinary assessment (physical and mental health, functioning and physical and social environments) and a care plan based on this assessment, usually delivered by a multidisciplinary team. The CGA process is known to improve outcomes for community-dwelling older people and those in receipt of hospital care, but less is known about its efficacy in care home residents.
Realist review was selected as the most appropriate method to explore the complex nature of the care home setting and multidisciplinary delivery of care. The aim of the realist review is to identify and characterise a programme theory that underpins the CGA intervention. The realist review will extract data from research articles which describe the causal mechanisms through which the practice of CGA generates outcomes. The focus of the intervention is care homes, and the outcomes of interest are health-related quality of life and satisfaction with services; for both residents and staff. Further outcomes may include appropriate use of National Health Service services and resources of older care home residents. The review will proceed through three stages: (1) identifying the candidate programme theories that underpin CGA through interviews with key stakeholders, systematic search of the peer-reviewed and non-peer-reviewed evidence, (2) identifying the evidence relevant to CGA in UK care homes and refining the programme theories through refining and iterating the systematic search, lateral searches and seeking further information from study authors and (3) analysis and synthesis of evidence, involving the testing of the programme theories.
The PEACH project was identified as service development following submission to the UK Health Research Authority and subsequent review by the University of Nottingham Research Ethics Committee. The study protocols have been reviewed as part of good governance by the Nottinghamshire Healthcare Foundation Trust. We aim to publish this realist review in a peer-reviewed journal with international readership. We will disseminate findings to public and stakeholders using knowledge mobilisation techniques. Stakeholders will include the Quality Improvement Collaboratives within PEACH study. National networks, such as British Society of Gerontology and National Care Association will be approached for wider dissemination.
The realist review has been registered on International Prospective Register of Systematic Reviews (PROSPERO 2017: CRD42017062601).
养老院居民对医疗资源的使用相对较多，且需求可能较为复杂。综合老年评估（CGA）可能使养老院居民受益，并提高护理服务的效率。这是一种护理方法，即进行全面的多学科评估（包括身心健康、功能以及身体和社会环境），并基于此评估制定护理计划，通常由多学科团队实施。已知CGA流程能改善社区老年人和接受医院护理者的预后，但对于其在养老院居民中的疗效了解较少。
选择现实主义综述作为最合适的方法，以探究养老院环境的复杂性和护理的多学科提供情况。现实主义综述的目的是识别并描述支撑CGA干预的项目理论。该现实主义综述将从研究文章中提取数据，这些文章描述了CGA实践产生结果的因果机制。干预的重点是养老院，关注的结果是与健康相关的生活质量以及居民和工作人员对服务的满意度；其他结果可能包括老年养老院居民对国家医疗服务体系服务和资源的合理使用。综述将分三个阶段进行：（1）通过与关键利益相关者访谈、系统检索同行评审和非同行评审证据，识别支撑CGA的候选项目理论；（2）识别英国养老院中与CGA相关的证据，并通过完善和反复进行系统检索、横向检索以及向研究作者寻求更多信息来完善项目理论；（3）对证据进行分析和综合，包括对项目理论的检验。
PEACH项目在提交给英国健康研究管理局并经诺丁汉大学研究伦理委员会后续审查后，被确定为服务发展项目。该研究方案已作为良好治理的一部分，由诺丁汉郡医疗保健基金会信托基金进行了审查。我们旨在将这一现实主义综述发表在具有国际读者群的同行评审期刊上。我们将使用知识传播技术向公众和利益相关者传播研究结果。利益相关者将包括PEACH研究中的质量改进协作组织。将与英国老年学学会和国家护理协会等全国性网络联系，以进行更广泛的传播。
该现实主义综述已在国际系统评价前瞻性注册库（PROSPERO 2017：CRD42017062601）注册。
