to assist people with disabling conditions (Batavia and DeJong, 1990). In limiting the discussion to these services only, the discussion will not directly address the organization, financing, and delivery of social and vocational services that, although important to the enabling process, are not traditionally thought of as part of the health care system. However, it is important to underscore the need to develop and evaluate better mechanisms of integrating the delivery of health and social-vocational services; the existing fragmentation of these services is of major concern.

Second, this chapter primarily focuses on the organization, financing, and delivery of post-acute care services. The committee recognizes the important role that access to quality care in the acute clinical care setting plays in minimizing the life-long consequences of disabling injuries and illness. It also recognizes that although a growing literature exists on the clinical effectiveness of acute care interventions, much of this literature falls short in identifying the impact of alternative treatment strategies on long-term functional outcomes and quality of life. The needs for research in this area, although not detailed in this chapter, are critical to an overall strategy of improving and enhancing life following major illness or injury.

Several landmark publications have discussed HSR priorities in rehabilitation and engineering (DeJong et al., 1989; Batavia et al., 1991; U.S. Department of Health and Human Services, 1995) The agenda for research encompasses a broad range of substantive and methodological issues; the committee chose to focus on three areas in which more research is particularly important if society is to better ensure that people with disabling conditions have access to the best possible care at costs that are affordable to the individual consumer and to society as a whole. They are as follows:

  • Demonstrating the cost-effectiveness of clinical interventions and alternative service delivery models. This research must incorporate a broad range of outcomes, including impairment, functional status, and quality of life, as measures of effectiveness.
  • Evaluating how primary health care and long-term support services are accessed, organized, and delivered for people with disabling conditions. The impacts of these services on the prevention of secondary conditions and promotion of well-being over the lifecourse should be given the highest priority.
  • Evaluating the impact of managed care delivery systems on access to and use of services, quality of care, costs, and outcomes. This work should extend beyond the evaluation of Medicaid and Medicare programs to include assessments of innovative programs targeted at working adults with disabling conditions.

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