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Health Services and Delivery Research
ISSN 2050-4349 · National Institute for Health Research · 346 artikel di indeks
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Artikel Jurnal
Theory and practical guidance for effective de-implementation of practices across health and care services: a realist synthesis
Background: Health-care systems across the globe are facing increased pressures to balance the efficient use of resources and at the same time provide high-quality care. There is greater requirement for services to be evidence based, but practices that are of limited clinical effectiveness or…
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Increasing specialist intensity at weekends to improve outcomes for patients undergoing emergency hospital admission: the HiSLAC two-phase mixed-methods study
Background: NHS England’s 7-day services policy comprised 10 standards to improve access to quality health care across all days of the week. Six standards targeted hospital specialists on the assumption that their absence caused the higher mortality associated with weekend hospital admission: the…
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Remediation programmes for practising doctors to restore patient safety: the RESTORE realist review
Background: An underperforming doctor puts patient safety at risk. Remediation is an intervention intended to address underperformance and return a doctor to safe practice. Used in health-care systems all over the world, it has clear implications for both patient safety and doctor retention in the…
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Synthesis for health services and policy: case studies in the scoping of reviews
Background: For systematic reviews to be rigorous, deliverable and useful, they need a well-defined review question. Scoping for a review also requires the specification of clear inclusion criteria and planned synthesis methods. Guidance is lacking on how to develop these, especially in the context…
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Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study
Background: Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires…
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Developing an evidence-based online method of linking behaviour change techniques and theoretical mechanisms of action: a multiple methods study
Background: Many global health challenges may be targeted by changing people’s behaviour. Behaviours including cigarette smoking, physical inactivity and alcohol misuse, as well as certain dietary behaviours, contribute to deaths and disability by increasing the risk of cancers, cardiovascular…
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Improving care transfers for homeless patients after hospital discharge: a realist evaluation
Background: In 2013, 70% of people who were homeless on admission to hospital were discharged back to the street without having their care and support needs addressed. In response, the UK government provided funding for 52 new specialist homeless hospital discharge schemes. This study employed…
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STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis
Background: Drug-related problems and potentially inappropriate prescribing impose a huge burden on patients and the health-care system. The most widely used tools for appropriate prescription in older adults in England and in other European countries are the Screening Tool of Older People’s…
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Understanding health-care outcomes of older people with cognitive impairment and/or dementia admitted to hospital: a mixed-methods study
Background: Cognitive impairment is common in older people admitted to hospital, but previous research has focused on single conditions. Objective: This project sits in phase 0/1 of the Medical Research Council Framework for the Development and Evaluation of Complex Interventions. It aims to…
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Acute day units in non-residential settings for people in mental health crisis: the AD-CARE mixed-methods study
Background: For people in mental health crisis, acute day units provide daily structured sessions and peer support in non-residential settings as an alternative to crisis resolution teams. Objectives: To investigate the provision, effectiveness, intervention acceptability and re-admission rates of…
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Promoting physical activity and physical function in people with long-term conditions in primary care: the Function First realist synthesis with co-design
Background: As people age and accumulate long-term conditions, their physical activity and physical function declines, resulting in disability and loss of independence. Primary care is well placed to empower individuals and communities to reduce this decline; however, the best approach is…
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Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study
Background: People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap. Objectives: The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with…
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Dental therapists compared with general dental practitioners for undertaking check-ups in low-risk patients: pilot RCT with realist evaluation
Background: Many dental ‘check-ups’ in the NHS result in no further treatment. The patient is examined by a dentist and returned to the recall list for a further check-up, commonly in 6 or 12 months’ time. As the oral health of regular dental attenders continues to improve, it is likely that an…
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Respite care and short breaks for young adults aged 18–40 with complex health-care needs: mixed-methods systematic review and conceptual framework development
Background: The number of young adults with complex health-care needs due to life-limiting conditions/complex physical disability has risen significantly over the last 15 years, as more children now survive into adulthood. The transition from children to adult services may disrupt provision of…
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Variation in availability and use of surgical care for female urinary incontinence: a mixed-methods study
Background: Urinary incontinence affects between 25% and 45% of women. The availability and quality of services is variable and inequitable, but our understanding of the drivers is incomplete. Objectives: The objectives of the study were to model patient, specialist clinician, primary and secondary…
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Large-scale implementation of stroke early supported discharge: the WISE realist mixed-methods study
Background: In England, the provision of early supported discharge is recommended as part of an evidence-based stroke care pathway. Objectives: To investigate the effectiveness of early supported discharge services when implemented at scale in practice and to understand how the context within which…
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Artikel Jurnal
Models of generalist and specialist care in smaller hospitals in England: a mixed-methods study
Background: The increasing number of older, complex patients who require emergency admission to hospital has prompted calls for better models of medical generalist care, especially for smaller hospitals, whose size constrains resources and staffing. Objective: To investigate the strengths and…
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Hospital-based specialist palliative care compared with usual care for adults with advanced illness and their caregivers: a systematic review
Background: Most deaths still take place in hospital; cost-effective commissioning of end-of-life resources is a priority. This review provides clarity on the effectiveness of hospital-based specialist palliative care. Objectives: The objectives were to assess the effectiveness and…
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Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review
Objectives: The study aimed to provide a mapping review of non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings; classify intervention components using the behaviour change technique taxonomy; explore evidence of behaviour change techniques and…
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Artikel Jurnal
GPs’ involvement to improve care quality in care homes in the UK: a realist review
Background: Organising health-care services for residents living in care homes is an important area of development in the UK and elsewhere. Medical care is provided by general practitioners in the UK, and the unique arrangement of the NHS means that general practitioners are also gatekeepers to…