{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T16:04:38Z","timestamp":1779984278477,"version":"3.53.1"},"reference-count":32,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health and Care Research Academy","award":["NIHR303605"],"award-info":[{"award-number":["NIHR303605"]}]},{"name":"National Institute for Health and Care Research (NIHR) Applied Research Collaborations Yorkshire and Humber","award":["NIHR209634"],"award-info":[{"award-number":["NIHR209634"]}]},{"name":"National Institute for Health and Care Research, Yorkshire and Humber Applied Research Collaborations","award":["NIHR200166"],"award-info":[{"award-number":["NIHR200166"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,12]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Older people living in care homes are at increased risk of harm during acute hospital admissions. In England, care home residents have more than twice as many emergency department (ED) attendances as people of the same age living at home. Up to 40% of emergency hospital admissions of older care home residents may be avoidable with different models of care within their homes.<\/jats:p>\n                    <jats:p>In 2023, National Health Service England introduced the updated Enhanced Health in Care Homes (EHCH) framework, a set of recommendations to support \u2018joined up\u2019 and enhanced care for people living in care homes. A stated aim of the framework is to reduce ED attendances and inpatient admissions of residents. There is limited available evidence regarding how implementation of the EHCH framework differs regionally and whether variation in implementation may impact on hospitalisations of care home residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We aim to explore regional differences in care elements developed from the EHCH framework and assess how these differences may contribute to variation in hospitalisations of care home residents over the age of 65.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a comparative qualitative case study of six care home-containing postcode districts in England embedded within three Integrated Care Boards (ICBs). ICBs are regional organisations responsible for commissioning healthcare services in England. Case study districts and ICBs were selected due to contrasting case-mix adjusted admission rates and other characteristics (eg, deprivation). Data will be collected through semistructured interviews. We will interview health and social care professionals who are responsible for commissioning, overseeing and delivering enhanced care in care homes, care home professionals, residents over the age of 65 and their family and friends. Interview data will be analysed through a framework approach, with comparisons drawn within cases, across cases and across ICBs. Through our analysis, we will characterise the EHCH framework care elements and identify differences in implementation that may cause variation in hospital admissions. We will also identify perceived appropriate, effective and replicable enhanced care models.<\/jats:p>\n                    <jats:p>Patients and the public have informed the design of this study, and will advise the research practice, support the analysis of data and guide dissemination plans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has received Social Care Research Ethics and Health Research Authority Approval (25\/IEC08\/0014). All participants will be required to provide informed consent. The findings will inform a national survey of ICBs to map appropriate and effective enhanced care in England. Findings will be shared with key stakeholders and academic audiences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-112414","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T15:25:19Z","timestamp":1779981919000},"page":"e112414","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Investigating differences in the implementation and experience of the Enhanced Health in Care Homes Framework in England: a qualitative protocol for the Understanding Variation in Admissions from Care Homes (UVAC) study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3043-7564","authenticated-orcid":false,"given":"Carl","family":"Marincowitz","sequence":"first","affiliation":[{"name":"ScHARR, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1415-7194","authenticated-orcid":false,"given":"Katherine Elizabeth","family":"Zwerger","sequence":"additional","affiliation":[{"name":"Health Services Research, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fawn","family":"Harrad-Hyde","sequence":"additional","affiliation":[{"name":"University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Garrett","sequence":"additional","affiliation":[{"name":"Health Data Research UK, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Lam","sequence":"additional","affiliation":[{"name":"Health Data Research UK, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4752-6988","authenticated-orcid":false,"given":"Jennifer","family":"Burton","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Reeve","sequence":"additional","affiliation":[{"name":"Academy of Primary Care, Hull York Medical School, Hull, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1701-0577","authenticated-orcid":false,"given":"Suzanne M","family":"Mason","sequence":"additional","affiliation":[{"name":"School of Medicine and Population Health, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6908-0032","authenticated-orcid":false,"given":"Karen","family":"Spilsbury","sequence":"additional","affiliation":[{"name":"School of Healthcare, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9728-9992","authenticated-orcid":false,"given":"David B","family":"Price","sequence":"additional","affiliation":[{"name":"Optimum Patient Care, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6710-5403","authenticated-orcid":false,"given":"Richard M","family":"Jacques","sequence":"additional","affiliation":[{"name":"School of Medicine and Population Health, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1979-7577","authenticated-orcid":false,"given":"Graham","family":"Martin","sequence":"additional","affiliation":[{"name":"University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"2026052808251132000_16.5.e112414.1","unstructured":"Older people living in care homes in 2021 and changes since. 2011."},{"key":"2026052808251132000_16.5.e112414.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/cky241"},{"key":"2026052808251132000_16.5.e112414.3","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afac007","article-title":"Patient-related risk factors for in-hospital functional decline in older adults: A systematic review and meta-analysis","volume":"51","author":"Geyskens","year":"2022","journal-title":"Age Ageing"},{"key":"2026052808251132000_16.5.e112414.4","unstructured":"The state of health care and adult social care in England 2022\/2023. 2023."},{"key":"2026052808251132000_16.5.e112414.5","unstructured":"The state of health care and adult social care in england 2023\/2024. 2024."},{"key":"2026052808251132000_16.5.e112414.6","unstructured":"Written evidence submitted by the royal college of emergency medicine (AED0001): addendum to the topical session on A&E. 2023."},{"key":"2026052808251132000_16.5.e112414.7","unstructured":"Reeves C , Islam A , Gentry T . 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