Work Package 1: Research in and with care homes
Work Package 1 (WP1) is co-led by Dr Sarah Kelly (University of Cambridge) and Dr Guy Peryer (The University of East Anglia). The work package is divided into two parts – Review 1 and Review 2. The aims of these two reviews are to:
- Provide an overview of outcomes and care quality for residents relating to interventions in care homes
- Provide a synthesis of the evidence from ‘process evaluations’ of interventions conducted in care homes
What is an intervention?
An intervention is a combination of strategies designed to improve health status among a group of individuals or an entire population.
What is a process evaluation?
Process evaluations are usually conducted simultaneously with outcome evaluations such as randomised controlled trials (RCT). They examine the processes through which an intervention works, such as the relationship between the care home staff and the tools and technologies used in the care home.
What is a randomised controlled trial (RCT)?
An RCT is a type of scientific (often medical) experiment that is viewed as the best way to test the effectiveness of new treatments.
Why it is needed
Care homes, commissioners and regulators collect and hold a lot of information about care home residents’ medical history, needs, preferences and care. At present there is no consistent approach to how this is done with consent (including those with dementia) nor how it is used securely. Different people collect different information in different ways, making it difficult to understand the care needs of care home residents and how these are met as they move between organisations. Consequences include duplication of effort, some needs not being identified or reviewed, feelings of frustration and failures in communication. A more consistent approach to how information about care home residents is recorded and handled is needed. An agreed data set (a Minimum Data Set) would help researchers and practitioners enhance the care and quality of life for residents, families, and staff.
WP1 will help to inform the DACHA study by sharing what key measures and outcomes have been incorporated in UK care home research through interventions and process evaluations in care homes. The two reviews in this work package will guide further work packages on what information should be prioritised in implementing (applying/administering) a minimum data set (MDS), and provide future resources for researchers and commissioners.
Methods being used in WP1
Both reviews will use high quality evidence synthesis methods.
- Review 1 will examine RCTs, experiments and implementation studies conducted in care homes. It will focus on the range of interventions conducted in care homes in OECD countries since 2015 to reflect contemporary research practice. Included studies will be categorised by outcome categories (e.g. cognitive ability, function, quality of life, quality of care, etc.). The review will highlight the frequency of use of these measures across studies and if they are sensitive enough to measure change in outcomes for residents.
- Review 2 will provide a synthesis of the evidence from process evaluations of interventions conducted in care homes. Itwill identify common factors from previously published studies that have reported a process evaluation that may affect outcomes and the quality of implementation. Taking a human-factors approach, previous studies will be reviewed to highlight the relationship between the physical environment, tools and technologies, care tasks, and the carer/resident in the context of a care home.
Why findings are important
WP1 will identify a list of relevant factors that influence implementation of care interventions in care homes, and identify outcomes for residents and outcome measures that have been used in care home research. This will also inform implementation of an MDS. The output will provide guidance and resources for researchers and commissioners aiming to test and implement health and care interventions in care homes.
Dr Sarah Kelly, University of Cambridge: firstname.lastname@example.org
Dr Guy Peryer, University of East Anglia: G.Peryer@uea.ac.uk
This work responds to the research brief’s identification of the need for evidence that can both improve the productivity of care home research and capture the key measures and outcomes used in UK care home research that could inform a MDS.
Review One is led by Dr Sarah Kelly at University of Cambridge
This will provide an overview of resident reported outcomes and care quality relating to interventions or programme implementation in care homes, and any evidence of sensitivity to change. Attention will be paid to the use of functional and quality of life measures. Based on our prior work we anticipate considerable heterogeneity and knowledge gaps (e.g. in resident/family reported outcome measures). By identifying those outcomes measured in care home studies that are sensitive to change, clinically meaningful, and address the lived experience of the older people resident in care homes this review will both be a resource for researchers planning future work and inform the work of developing a MDS.
The review will include RCTs, pragmatic trials, natural experiments and implementation studies. It will focus on the range of interventions conducted in care homes since 2009 to reflect contemporary research practice. Included studies will be categorised by focus and outcome categories (e.g. cognitive ability, function, quality of life and care) and analysis will consider frequency of use across studies and data on the feasibility and utility of the outcome measures used.
Review 1 will systematically identify trials, outcome and contextual measures that have been conducted in care homes to directly inform WP2 and 3. It will collate a list of outcome measures and other contextual measures of relevance to resident outcomes that have been used in care home studies to date. Measures of relevance to quality of life, quality of care, relational and patient-centred care will be identified for consideration for possible inclusion in the MDS. The analysis will consider the frequency of a measure’s use across studies and the feasibility and utility of a measure within an MDS, and any evidence of sensitivity to change. The data collected will inform the prioritisation of datasets of most value to the MDS for linkage in WP4 and decisions on the content of the final MDS for piloting in WP5.
Review Two is led by Dr Guy Peryer at University of East Anglia
This will provide a synthesis of the evidence from process evaluations of complex interventions conducted in UK care homes. The process of delivering an intervention in a care home setting can mediate the validity of the outcome measures directly. A process evaluation describes how delivery is achieved, what is actually delivered, how the delivered intervention was reported as producing change, and what affected implementation and outcomes. WP1 will synthesise implementation factors that have been argued within published process evaluations of care home research to have influenced study outcomes.
Evidence from review 2 will inform the pilot implementation of the MDS in WP5 and inform the interview topics for the assessment of potential barriers and facilitators to wider implementation in WP5.This will be complemented by an early deliverable; a guide to researchers, to support and improve the design, conduct, and impact of future health services research in the care home sector.
Review 2, by producing a synthesis of process evaluations of care home research, will provide further in-depth evidence of factors that influence resident outcomes that may not have been directly measured in research or data systems to date, and that could be of importance to care home research in the future that could be considered for inclusion within the MDS. This evidence synthesis will identify common factors from previously published studies and programmes that have reported a process evaluation that may affect outcomes, fidelity, and quality of implementation. Taking a human-factors approach to data organisation and analysis, it will examine the relationship between the organisational context of care homes involving a subset of embedded work systems: i) physical environment, ii) tools and technologies, iii) care tasks, and iv) the carer/resident. This fits with the design principles of stakeholder engagement (41) with care home staff that places the resident at the centre of the work system model.
Both reviews use high quality evidence synthesis methods, with protocols registered on PROSPERO https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=155923