Wirkungen und Effekte des Resident Assessment Instrument (RAI Home Care 2.0) in der ambulanten Pflege in Deutschland

Abstract

Background: Quality deficits in long term care services have been frequently addressed and cause costs as a result of inadequate care giving. Instruments that can grant a steady increase in care quality will be required, especially considering the current demographic aging. International studies are showing that the implementation of the Resident Assessment Instrument (RAI) can increase care quality. Objective: The aim of this thesis is to describe the method how RAI can act as an effective quality improvement instrument, to show the effects of the implementation on home care services in Germany, and to point out circumstances that might hinder a successful execution of RAI. Methods: The effectiveness of RAI and the impact of RAI on the documentation of the care process, the care recipients condition, the job situation of caregivers, as well as on the situation of applying care services are illustrated alongside system theoretical considerations. The results of a randomized controlled trial study (RCT) financed by the German Ministry of Education and Research (BMBF) constitute the data basis. This data are collectet by interviews in 69 care services (36 treatment groups, 33 control groups) with 484 clients (268 from treatment groups versus 216 from control groups) and nearly 500 caregivers surveyed over a 12 month period. Additionally, further quantitative and qualitative data was collected. Results: RAI does, in part, lead to positive effects on central elements of the care process. However, RAI controlled documentation does not provide evidence for improvements in optimizing the care process. Therefore, no significant changes in health care services could be measured. Also, there was no measurable impact of RAI on the condition of care recipients, the workload of caregivers, or the situation of home care services. Various implementation barriers were detected on the care services and caregivers, so that the extent to which RAI was applied by home care services varied. A subgroup analysis implies an intensive application of RAI can have positive effects on the condition of care recipients and the caregivers job satisfaction. Conclusion: The implementation of RAI in German home care services though accompanied by certain problems proved to be successful in the optimization of care processes. In order to benefit from the implementation of RAI, a careful and methodical project management are of the essence. Otherwise, RAI might even have a negative impact on both persons in need of care and caregivers.