REFINING THE PROGRAMME THEORYCASE STUDIES IN CARE HOMES FROM THREE DISCRETE CARE ECONOMIES

To further develop the programme theory, three geographically discrete areas were identified with models of health care emphasising respectively: expertise in care of older adults organised around the care home; incentive-driven care using general practitioners (GPs) as co-ordinators; and mixed provision typical of usual UK care delivery. 242 residents from 12 care homes had baseline health status described using the InterRAI-LTC and their healthcare resource use and associated costs over 12 months collated. Interviews and focus groups with 181 health and social care professionals, residents and families described the care received. Healthcare costs per resident were greatest where provision was ad hoc and mixed. GP contacts and costs were greater where incentives emphasised GP contact. The most positive accounts were of models which recognised the pivotal role of homes in healthcare delivery, supported effective relational working between health and social care staff and allowed GPs to focus on medical care.