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Implementation of the Resident Assessment Instrument (RAI) as a quality development and control tool in inpatient long-term care

Short title

  • RAI Project / T1

Period

  • 02/2007 - 01/2010

Leadership

Staff members

  • Dr. Yvonne Selinger
  • Karina Targan

Associate partners

  • Prof. Dr. V. Garms-Homolová, representative of interrai for Germany
  • Q-Sys Working Group, St. Gallen
  • Project A1 des Nursing Research Network North: G. Roth / H. Rothgang: Improving the effectiveness and efficiency of outpatient care at home by the Resident Assessment Instrument (RAI-HomeCare 2.0)

Support

  • Federal Ministry of Education and Research as part of the research program "Applied Nursing Research" in Nursing Research Network Middle-South 

Abstract

Background

The Resident Assessment Instrument is mandatory in publicly funded nursing homes in the United States. Numerous studies in the U.S. and now also in Europe have demonstrated sustainably the improvement of the process as well as the outcome quality of long-term care through the introduction and implementation of the RAI. Its measurement validity and the interrater reliability of the modules are confirmed (Hawes 1997, Austin 2004). Brandenburger (2002: 99) notes that the RAI provides explicit conditions for improving the quality of care, which was detected by Haxes / Vladeck (2005: 6-45) after implementation of the RAI in American nursing homes, especially in the area of process and outcome quality. Bernabei / Panfilo / Panio (2005: 99-117) concretise the achievements of the introduction of RAI in Italian nursing institutions, demonstrated by an improved care planning process and improved documentation. In the context of case management the hospitalization rate such as the length of hospital stay was also reduced (ibid.).

Question 

The implementation study will answer the question of whether the implementation and use of the Resident Assessment Instrument (RAI) can improve the quality of care in nursing homes demonstrably.

Methods

A cluster-randomized  controlled study will examine whether the implementation of the RAI in nursing homes leads to an improvement of the quality of the care provided. The 14 nursing homes included in the study will be divided into an intervention group with 7 homes, in which the RAI will be implemented, and a control group with the other 7 homes, in which the RAI will not be used. A total of 980 residents (40% drop-out taken into account) are included in the study.

In-house training for all the nurses in the nursing homes, who are responsible for the organization of the care process for the residents, will prepare them for the implementation and use of the RAI. The two-day course will provide training in the utilization of the RAI - based on the RAI manual - and also training in the basics of the nursing process and nursing documentation.

The measurements for the evaluation will be made in the institutions where the RAI is implemented as well as in the homes of the control group, keeping to the prescribed RAI time assessment in 6 month stages over a period of 1.5 years. Following these 18 months, , the rescheduled training and the accompanied implementation of the RAI will take place in the control group as well. Furthermore, nursing documentation analysis and interviews with nurses / residents regarding their health-related quality of life will be conducted. The quality of the implementation of the intervention will be shown by means of plausibility checks.

Expected Results

It is expected that on the residents’ level the intervention will lead to an improvement of the residents’ outcomes and of the quality of care when compared to the control group. An increase of the health-related quality of life is expected on the level of the residents and nurses. In addition, an improvement in the quality of nursing documentation and process planning is assumed.

Publications

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