Improving care in care homes: what can Primary Care Networks learn from the Vanguards?
Improving care in care homes: what can Primary Care Networks learn from the Vanguards?
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DOI：
10.1108/jica-06-2020-0037
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发表时间：
2020-08-24
影响因子：
0.8
通讯作者：
Checkland, Kath
中科院分区：
文献类型：
--
作者：
Coleman, Anna;Croke, Sarah;Checkland, Kath
目的我们追溯了英国NHS新的综合护理政策（加强护理院的健康，EHCH）的演变，从试点模式到更广泛的推广，在4年的时间里，进入COVID-19的情况。设计/方法/方式使用已公布的证据和官方文件，我们比较和对比原始EHCH模型/框架，随后的草案规范和最终的建议，提前实施。结果-初级保健网络EHCH服务规范显然是从先锋计划中产生的;然而，与GP合同和COVID-19相关的问题意味着，至少在最初，谁负责交付可能会有一些变化。目前尚不清楚在目前情况下按进度提供的这项服务是否会实现或影响试点项目所设想的成果。研究限制/影响-这是我们的解释发展政策，提高保健院，这需要进一步的后续研究。我们将于2020年夏季开始最后的实地考察阶段，以报告先锋的遗产。实际影响-政策的成功/失败的评价应考虑的背景和不同的权力关系，存在的，并可能影响随后的整个系统的接受和推出。我们建议采取纵向办法，以便能够对政策执行情况有一个整体的看法。独创性/价值-本文揭示了在当前的气候健康和护理决策的脆弱性。从最初的概念，通过开发和测试，到被迫提前推出，我们的观察反映了全球大流行冲击的独特影响。
Purpose We trace the evolution of a new integrated care policy in the English NHS (enhanced health in care homes, EHCH) from pilot model to wider roll out, over a 4-year period, into the circumstances of COVID-19. Design/methodology/approach Using published evidence and official documentation we compared and contrasted the original EHCH model/framework, subsequent draft specifications and the final proposals, ahead of implementation. Findings The Primary Care Network EHCH service specification has clearly arisen from the Vanguard programme; however, problems related to GP contracts and COVID-19 means, at least initially, there is likely to be some variability over who will be responsible for delivery. It is unknown whether this service, delivered at pace in the current circumstances, will achieve or affect the outcomes envisaged by the pilots. Research limitations/implications This is our interpretation of the developing policy for enhanced health in care homes, which requires further follow-up research. We are beginning our final fieldwork phase in Summer 2020, to report on the Vanguard legacy. Practical implications Evaluations of policy success/failure should consider the context and the differing power relations that are present and may impact subsequent take-up and roll-out across the system. We recommend a longitudinal approach to enable a holistic view of policy implementation. Originality/value This paper reveals the fragility of health and care policymaking in the current climate. From initial concept, through development and testing, into forced early roll out, our observations reflect the unique impact of a global pandemic shock.