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Int J Nurs Pract. 2015 Oct;21(5):612-21. doi: 10.1111/ijn.12332. Epub 2014 Apr 28.

Improving health status and reduction of institutionalization in long-term care--Effects of the Resident Assessment Instrument-Home Care by degree of implementation.

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Zentrum für Sozialpolitik (ZeS), Universität Bremen, Bremen, Germany.
FGK Clinical Research GmbH, München, Germany.
Hochschule für angewandte Wissenschaften München, München, Germany.


A cluster randomized controlled trial showed that the Resident Assessment Instrument (RAI) could not improve or stabilize the health status of people in need of long-term care or reduce the rate of institutionalization in Germany among clients of home care agencies. The aim of this article is to investigate whether the effect of RAI depends on the degree of implementation. A factor analysis was used to distinguish between those agencies that implemented RAI intensively and those that did not. The clients of home care agencies working intensively with RAI were significantly less hospitalized (P = 0.0284) and fared slightly better according to activities of daily living (ADL, instrumental ADL (IADL)), cognitive skills (Mini-Mental Status Test (MMST)) and quality of life (EuroQol (EQ-5D)) compared with the control group. In contrast, those not working intensively with RAI had worse outcomes (IADL, MMST, EQ-5D) than the control group (not significant). It is important to guarantee a successful implementation of RAI.


home care agencies; hospitalization; outcome assessment; quality assurance

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