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    Cost-effectiveness of specific clinical interventions and service delivery systems. This research should incorporate a broad range of outcomes including impairment, functional status, and quality of life as measures of clinical and program effectiveness.

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    Access to and organization and delivery of services that address the primary health care and long-term support needs of 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.

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    The impact of managed care on access to and use of services, quality of care, cost, and outcomes. This work should extend beyond the evaluation of Medicaid and Medicare programs to include assessment of innovative programs targeted at working-age adults. Add-ons to major demonstrations of managed care delivery systems should be funded. These add-ons should specifically examine the impact of managed care on people with disabling conditions.

Recommendation 7.2 Establish Centers for the Organization, Delivery, and Financing of Health and Health-Related Services to People with Disabilities. These centers should be collaborative ventures across departments and schools in a university setting and should incorporate components of research, teaching, and community outreach service.

Recommendation 7.3 Develop transdisciplinary doctoral and postdoctoral training programs in health services research with an emphasis in rehabilitation and engineering. These programs should be designed for both clinicians and nonclinicians and emphasize the cross-disciplinary and interdisciplinary nature of the field. Special efforts should be made to encourage and facilitate such training among persons with disabilities. Additional funding would be required to support this activity.

Recommendation 7.4 Develop and maintain longitudinal databases that track the health care needs of people with disabling conditions, their use of services, and outcomes or health status. Specifically, the 1994-1995 Disability Supplement to the NHIS should be developed into a panel study and supported over time to perform maintenance and analysis activities. Additional funding would be required to support this activity.



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