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

Introduction 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. In 2023, National Health Service England introduced the updated Enhanced Health in Care Homes (EHCH) framework, a set of recommendations to support 'joined up' 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.

Aims 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.