potential options or solutions for the problems identified. Given resource and time constraints, however, priorities need to be established. Moving from identifying alternative solutions or prototypes to proposing viable solutions requires iterative small-scale testing using available knowledge, pilot testing the prototypes, and conducting simulation studies prior to refining the prototype decision process so that it will work well with real subjects.
Once a viable prototype is developed to replace the existing disability decision process, two questions need to be answered: (1) is the prototype workable in the real world? and (2) will it alleviate the problems identified with the current process? Following successful pilot testing of the prototype, the next step involves field evaluation. Such evaluation includes field tests and national surveys that enables the agency to make needed changes and to answer questions, such as what is the best way to decide if a person is sufficiently “disabled” to be eligible for benefits. Randomized controlled experiments and clinical trials in addition to field evaluation sometimes serve a useful purpose.
Assessing if a proposed prototype can be implemented is only one part of the solution. A necessary step is to examine if a proposed redesigned decision process will produce the improvements it is meant to deliver and at what cost. Research methods that are often used include simulation, modeling, and analyses of data using information from small-scale tests, field evaluation, program evaluation, and surveys conducted in-house or by other organizations, such as the Bureau of the Census and the National Center for Health Statistics. Prospective cost-effectiveness and cost-benefit studies to measure efficiency may seem ideal intellectually, but often they are impractical in terms of costs and timeliness. Practical approaches must take into account constraints of time and available resources. Process engineering research with the aim to control costs of the proposed decision process may also be useful.
At this stage of the research the proposed prototype should be tested in a real life environment and evaluated relative to the same criteria that were initially applied to assessment of the current disability decision process. The findings then should be compared with those obtained from the existing program. The various prototypes tested will have different strengths and weaknesses, and the selection of the prototype for implementation will involve, at least to some extent, political programmatic decisions concerning priorities and budget.
The next chapter reviews, in the context of the framework for a research design outlined in Table 3-1, the research plan developed by SSA, the individual projects under this plan that are completed and underway, the proposed sequence and timeline for completion of the individual projects, and the implications of each project for the overall plan. The chapter also identifies the gaps to be filled with proposed additional research.