Work Package 3

A mixed methods work package looking at enhanced care in care homes across England and revisiting the statistical tools from Work Package 1.

Work Package Aims & Objectives

The aims of this work package are:

Identify replicable safe and effective models of enhanced care which can help develop the Enhanced Health in Care Homes Framework.
Develop statistical tools to help monitor and plan services for care homes.

This will be achieve through the four following objectives:

Triangulate attendance and admission rates with other outcomes (e.g., place of death) available in WP 1, alongside resident, family members and care home staff experiences of enhanced care services to characterise the quality and safety of care associated with variation.

Survey the care home leads of each integrated care system nationally to assess where the specific models of enhanced care elements identified in WP 2 are present across England.

Using the survey findings, revisit the multi-level regression to incorporate predictors for models of enhanced care elements in different Integrated Care Systems. This will deliver (a) better prediction of expected attendances/admissions, (b) a new assessment of how far above or below predicted each postcode district containing one or more care home is, (c) estimates of the association between specific models of enhanced care elements and attendances/admissions.

Working with stakeholders, integrate findings across WP1, 2 and 3 to develop statistical tools useable by commissioners or regulators to identify areas with unexpectedly high rates of attendance/admission to help monitor and prioritise development of the Enhanced Health in Care Homes Framework.

Planned Investigation

Survey

WP2 will identify models of enhanced care present in case study postcode districts embedded within ICSs which are thought to contribute to observed variation in ED attendances/hospital admission from care homes. We will map where similar enhanced care models are present nationally by surveying the Care Home Lead/Urgent & Emergency Care Programme Managers for each ICS in England. This will allow mapping of similar enhanced services by ICS. The Urgent & Emergency Care Programme Leader and Manager for the South Yorkshire ICS will help facilitate contact with Leaders and Managers in other ICSs to facilitate the survey.

Revisiting the Multi-level Model

The models developed in WP1 cluster residents by care home containing postcode district and care homes by ICS but only adjusts for resident and care home level factors. Using the survey findings, predictors for specific types of enhanced care elements for each ICS in the dataset will be added to the model. This will estimate new models with improved prediction and measure association between specific types of services and attendances/admissions.

Approvals

Before beginning WP3 of this study, we will seek Health Research Authority approval and ethical approval from the University of Sheffield Research Ethics committee.

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