Fewer Admissions to Hospital and Nursing Homes among Clients of Home Care Services through Better Care Planning and Management? Findings from a Cluster Randomised Controlled Trial in Germany

Abstract

Aim of the study: The present study evaluates whether the Resident Assessment Instrument (RAI-HC) can improve the quality of care in home care services in Germany. As surveys continuously reveal, the elderly prefer to stay at home once they are in need of long-term care. The rate of institutionalisation (hospitalisation and moving to a nursing home) is therefore regarded as a measurement of the quality of home care.

Design and methods: A cluster randomised controlled trial was conducted to assess whether the Resident Assessment Instrument - Home Care (RAI-HC) can help to reduce institutionalisation among clients of home care services. Sixty-nine German home care services were included and randomised.

Results: There are fewer admissions to hospital among clients in the treatment group, but effects are not significant. The degree of implementation of RAI, however, differed among services. Therefore, two subgroups, ‘optimal’ and ‘sub-optimal’ users, are distinguished. Clients from services with an better implementation are significantly more likely to have no hospital admission compared to clients in the control group. Clients in the treatment group (optimal and suboptimal RAI users) are more likely to move to nursing homes compared to clients in the control group, but effects are not significant.

Study limitations and conclusion: A reduced sample size might be the reason for non-significant results. Insufficient implementation could be another possible reason because the optimal users have fewer hospitalised clients. RAI might detect unsustainable care arrangements and therefore initiate more moves to nursing homes in the treatment group.

Keywords: Home care, long-term care, social and health services, quality assurance, assessment, hospitalisation, outcome, randomised controlled trial, Germany