Home care quality indicators based on the Resident Assessment Instrument-Home Care (RAI-HC): a systematic review

Area of Science:

• Healthcare Quality Measurement
• Gerontology
• Health Services Research

Background:

• Home care quality is often measured using quality indicators (QIs) derived from Resident Assessment Instrument-Home Care (RAI-HC) data.
• To ensure meaningful quality improvement and comparisons, RAI-HC QIs must demonstrate validity and reliability.
• This systematic review aimed to identify existing RAI-HC QIs and evaluate the evidence for their psychometric properties.

Purpose of the Study:

• To systematically identify currently existing RAI-HC QIs.
• To summarize the scientific knowledge on the validity and reliability of these RAI-HC QIs.
• To provide guidance for future research on improving RAI-HC QI validation.

Main Methods:

• A systematic review was conducted using multiple electronic databases (PubMed, CINAHL, Embase, PsycINFO, Cochrane Library).
• Studies describing the development or psychometric characteristics of RAI-HC QIs were included.
• The Appraisal of Indicators through Research and Evaluation (AIRE) instrument was used to assess the methodological quality of identified QI sets.

Main Results:

• Four studies met inclusion criteria, describing three RAI-HC QI sets with 48 unique QIs, primarily focusing on care outcomes.
• The validity and reliability of these identified RAI-HC QIs were generally not sufficiently tested.
• None of the evaluated QI sets achieved high methodological quality across all AIRE instrument domains.

Conclusions:

• This is the first systematic review appraising the scientific evidence on RAI-HC QI validity and reliability.
• Insufficient reporting of validation processes and reliability, along with a lack of state-of-the-art methodologies, were identified.
• Further investigations into RAI-HC QI reliability and validity are recommended, given their current use in home care quality assessment.