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Effects of the Resident Assessment Instrument in home care settings

Results of a cluster randomized controlled trial

Effekte des Resident Assessment Instrument in der ambulanten Pflege

Ergebnisse einer clusterrandomisierten kontrollierten Studie

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Zeitschrift für Gerontologie und Geriatrie Aims and scope Submit manuscript

Abstract

Deficits in quality, a lack of professional process management and, most importantly, neglect of outcome quality are criticized in long-term care. A cluster randomized, controlled trial was conducted to assess whether the Resident Assessment Instrument (RAI) can help to improve or stabilize functional abilities (ADL, IADL) and cognitive skills (MMST), improve quality of life (EQ-5D), and reduce institutionalization, thereby, increasing outcome quality. A total of 69 home care services throughout Germany were included and randomized. The treatment group (n=36) received training in RAI and was supported by the research team during the study (13 months). Comparison of mean differences between the treatment and control groups (n=33) showed no significant effect. Although the multilevel regression results show that clients in the treatment group fared better in terms of ADLs and IADLs (smaller decline) and were less likely to move to nursing homes and be hospitalized, none of these effects is significant. The lack of significance might result from the small number of clients included in the study. Moreover, RAI was not fully implemented and even partial implementation required more time than expected.

Zusammenfassung

In der Pflege werden Qualitätsdefizite, mangelnde Prozesssteuerung und vor allem die Vernachlässigung der Ergebnisqualität bemängelt. In einer clusterrandomisierten kontrollierten Studie wurde untersucht, inwieweit das Resident Assessment Instrument (RAI) eine Verbesserung oder Stabilisierung der funktionalen (ADL, IADL) und kognitiven Fähigkeiten (MMST) der Pflegebedürftigen sowie der Lebensqualität (EQ-5D) bzw. eine Verminderung der Hospitalisierung oder Institutionalisierung bewirken und damit die Ergebnisqualität verbessern kann. Dazu wurden 69 Pflegedienste rekrutiert und randomisiert. Die Interventionsgruppe (n=36) wurde im RAI geschult, über 13 Monate begleitet und unterstützt. Im Vergleich der Mittelwertdifferenzen ergibt sich bei keiner Zielgröße ein signifikanter Unterschied zur Kontrollgruppe (n=33). Zwar zeigen die Klienten der Interventionsgruppe in Multilevel-Regressionen bezüglich der ADL und IADL bessere Entwicklungen (geringere Verschlechterungen), weisen eine geringere Heimeinweisungsquote und weniger Krankenhausaufenthalte auf, allerdings ist keiner dieser Unterschiede signifikant. Die fehlenden Signifikanzen können zum Teil darauf zurückgeführt werden, dass die geplante Stichprobengröße nicht realisiert werden konnte. Zudem gelang die RAI-Umsetzung nicht vollständig bzw. dauerte länger als erwartet.

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Notes

  1. The ICC shows the variance between the clusters compared to the total variance [26].

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Acknowledgment

We would like to thank all participating home care service providers and people in need for care. The study was financed by the German Ministry of Education and Research (BMBF).

Conflict of interest

The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Zentrum für Sozialpolitik, Universität Bremen, 28359, Bremen, Deutschland

    C. Stolle, A. Wolter, G. Roth & H. Rothgang

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  1. C. Stolle
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  2. A. Wolter
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  3. G. Roth
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  4. H. Rothgang
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Correspondence to A. Wolter.

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Stolle, C., Wolter, A., Roth, G. et al. Effects of the Resident Assessment Instrument in home care settings. Z Gerontol Geriat 45, 315–322 (2012). https://doi.org/10.1007/s00391-011-0221-2

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  • DOI: https://doi.org/10.1007/s00391-011-0221-2

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