of working-age adults is growing faster than any other segment of the population with disabling conditions.

In general, there has been little interaction between the fields of HSR and rehabilitation science and engineering. In a review of articles published in 1986 in the Archives of Physical Medicine and Rehabilitation, Fuhrer (1988) found that only 6 percent were in the area of HSR. In 1995 this had increased to 22 percent—although nearly one half of these articles described the development or evaluation of functional outcome and disability measures without reference to the evaluation of services. Similarly, very few reports (less than 5 percent) in the major journals in HSR (e.g., Medical Care and Health Services Research) focus on issues of rehabilitation services delivery and outcomes.

Health Services Research Agenda

Influencing Trends

The development of a more comprehensive HSR agenda in rehabilitation science and engineering will be heavily influenced by three important trends in the epidemiology of disability and in the way that health services are organized and delivered (Batavia and DeJong, 1990). First, as significant strides in the clinical management of disabling conditions continue to be made, there will be increasing numbers of people with disabling conditions who are living longer and more active lives. This trend underscores the need for research that incorporates a life-long perspective and that focuses attention on the special needs of people who are aging with a disabling condition. Of critical importance is the development and evaluation of health delivery models that integrate a health promotion strategy that facilitates greater individual control over the determinants of health (Wallerstein, 1992). Equally important, however, is the recognition that disabling conditions are not deficits, but rather conditions of life. The management of a medically stable disabling condition is a personal matter first and a medical matter second (DeJong, 1979). It will be important to evaluate the success of alternative health care delivery models in terms of these parameters.

Second, due in large part to the independent living movement, the expectations of people with disabling conditions have changed drastically and will continue to change in important ways. People with disabling conditions have determined that they are no longer willing to accept life-long dependent relationships, and they want to promote a view of disability as a socially constructed phenomenon. Independent living recognizes that people with disabling conditions are consumers of services rather than patients or clients. At the same time that the indepen-



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