Evaluation of a pilot study to introduce outcome based home care in the Czech Republic

Abstract

ObjectivesTo evaluate a pilot study to introduce the outcome-based home care as part of a comprehensive client assessment system in Czech home care agencies. MethodsA prospective observational study was conducted with 13 home care agencies. Nurses were instructed to assess their home care clients with the Resident Assessment Instrument-Home Care (RAI-HC), an internationally developed comprehensive assessment instrument for home care clients. In addition, the perception of nurses regarding general acceptability and clinical and management relevance of the RAI-HC was evaluated using a questionnaire, which included certain items from a published Belgian study for general practitioners. Three quality indicators were calculated with proposed risk adjustment methods and the adjusted rates were compared with publicly available provincial averages in Canada. ResultsThirty-five home care nurses assessed 125 clients with the RAI-HC in total. The average time to complete one RAI-HC was 68min for the first time and 35min for the second. Based on established scales for activity of daily living, cognitive function and depression embedded in the RAI-HC, substantial difference in clients’ characteristics amongst agencies were observed. The nurse's perception of the RAI-HC was generally more positive compared to the Belgian general practitioners. The adjusted rates of quality indicators varied substantially amongst agencies and the average rates were almost identical with the provincial averages from Canada. ConclusionDespite the time consuming assessment, home care nurses perceived the benefit of using the RAI-HC in their daily practice. An outcome based home care using routinely collected comprehensive client assessment seems to be feasible in Czech home care agencies.