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J Am Med Dir Assoc. 2014 Sep;15(9):681-6. doi: 10.1016/j.jamda.2014.06.011. Epub 2014 Jul 30.

The optimal study: describing the key components of optimal health care delivery to UK care home residents: a research protocol.

Author information

  • 1Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK. Electronic address:
  • 2Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
  • 3Institute of Mental Health, University of Nottingham, Nottingham, UK.
  • 4Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK.
  • 5Division of Primary Care, University of Nottingham, Nottingham, UK.
  • 6School of Health Sciences, City University, London, UK.
  • 7School of Economics, University of Surrey, Guildford, UK.
  • 8Department of Primary Care and Population Health, University College London, London, UK.
  • 9Division of Health and Social Care Research, Kings College London, London, UK.
  • 10Department of Community Health Nursing and Health Studies, Brunel University, London, UK.


Long-term institutional care in the United Kingdom is provided by care homes. Residents have prevalent cognitive impairment and disability, have multiple diagnoses, and are subject to polypharmacy. Prevailing models of health care provision (ad hoc, reactive, and coordinated by general practitioners) result in unacceptable variability of care. A number of innovative responses to improve health care for care homes have been commissioned. The organization of health and social care in the United Kingdom is such that it is unlikely that a single solution to the problem of providing quality health care for care homes will be identified that can be used nationwide. Realist evaluation is a methodology that uses both qualitative and quantitative data to establish an in-depth understanding of what works, for whom, and in what settings. In this article we describe a protocol for using realist evaluation to understand the context, mechanisms, and outcomes that shape effective health care delivery to care home residents in the United Kingdom. By describing this novel approach, we hope to inform international discourse about research methodologies in long-term care settings internationally.

Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.


Nursing homes; delivery of health care; frail older adults; homes for the aged; research design

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