Added Value: The Complementary Role of Care Record Analysis and Key Informant Interviews in Understanding Current UK Nursing Home Care for Older Adults

Abstract

Reducing hospital admissions of older adults with ambulatory care sensitive conditions is a government priority. Yet relatively little is known about current health care practice in UK nursing homes. We studied approaches to developing understanding of current health care practices in UK nursing homes using a methodology of data-extraction from retrospective care home records combined with key informant interviews. Older adults with an exacerbation of one of 4 ambulatory sensitive conditions that warranted decision making around admission to hospital or continued primary-care led nursing home care were 178 identified and recruited for participation. Care home records were examined using a proforma for data-extraction. These data were combined with care-plans to construct a brief care narrative. The relevant progress notes/daily record of care-given at the time of the decision making were used to construct a visual time-line of events. For those participants who consented, the key multiple stake holders in care were identified: non-professional carers, care-home workers, caring professionals and care-managers. These data were used to generate supplementary trigger questions and topics for semi-structured interviews. This enabled questions raised by the care record to be identified and explored. Implications of the findings for practice and research will be discussed.