Objectives 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.
- comprehensive geriatric assessment
- care homes
- care planning
- quality in health care
- geriatric medicine
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Contributors NC, MZ and LS carried out searches, data extraction and theory was developed together with CG and AG. NC, CG and AG conducted synthesis with reflections and amendments from JRFG, TD and other authors. All authors have read and approved the final version.
Funding This work has been undertaken as part of the Proactive Healthcare in Care Homes (PEACH) study, funded by the Dunhill Medical Trust, award no FOP1/0115.
Competing interests None declared.
Ethics approval The protocol for the whole project, including the realist review, was submitted to UK Health Research Authority and University of Nottingham Research Ethics Committee; these committees identified the project as service development.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement This is a review of published or open access literature.
Patient consent for publication Not required.
Patient and public involvement One lay representative (family carer) was involved in designing the study and discussed resonance of findings with their lived experience. Early findings were presented to two dementia research patient and public involvement groups, two local GP patient participation groups and at engagement meetings held in three care homes which included residents and family members
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