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Table 1 Preliminary Programme theories developed from Stage 1

From: Effective health care for older people living and dying in care homes: a realist review

Health care for older people resident in care homes achieves optimal outcomes if How expressed in service delivery models/intervention research
System based quality improvement approaches incentivise health care staff (GPs and care home staff) regularly to visit and review residents’ health status then care home staff will prioritise the aspects of care activities that are being monitored, review of patient care and avoid inappropriate and avoidable use of urgent and emergency services Interventions that use financial payments, sanctions and audit to improve particular health care outcomes and adherence to protocols and guidance
Age-appropriate care can be accessed by older people resident in long term care. Then residents will not have to wait to have symptoms treated and then they will experience fewer episodes of avoidable ill health Interventions that focus on assessment maintenance and improvement of function, management of diseases and symptoms associated with old age through education, training of care home staff and access to visiting clinical experts and care home specialist teams
Interventions are predicated on establishing relational approaches that promote integrated working between visiting health care and care home staff. Staff will become less risk averse, trust each other’s opinions and be willing to engage with activities that promote residents’ health and support them to stay in the care home. Emphasis on strategies that support co-design and joint priority setting to achieve improved outcomes for residents, e.g. shared education and training, continuity of contact with particular clinical experts, shared learning, feedback on achievements between health and care home staff
  1. bold type denotes the working title of each programme theory