Enabling America Assessing the Role of Rehabilitation Science and Engineering (1997) / Chapter Skim
Currently Skimming:
7 RESEARCH ON THE ORGANIZATION, FINANCING, AND DELIVERY OF HEALTH SERVICES
7 RESEARCH ON THE ORGANIZATION, FINANCING, AND DELIVERY OF HEALTH SERVICES
Pages 170-190
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 170... ...
The multidisciplinary field of health services research has been successful in developing approaches for studying the roles of organization, finance, personnel, technology, and prevention in the provision of health services and their impact on utilization, cost, and quality of care (Steinwachs, 1991~. These methods have been applied across a broad range of populations and specific health conditions.
|
From page 171... ...
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 Delong, 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.
|
From page 172... ...
medical rehabilitation services required for improving and maintaining function, (2) primary health care services for health maintenance and the prevention of secondary conditions, (3)
|
From page 173... ...
· 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.
|
From page 174... ...
Rehabilitation services and outcomes studies should not only focus on the cost-effectiveness of specific treatments and therapies, as discussed in Chapter 4, but should also address the costs and benefits of innovative models and systems for delivering care. HSR has long recognized that the area of clinical effectiveness and outcomes research is central to its agenda.
|
From page 175... ...
traditional inpatient rehabilitation providers who have diversified and are offering subacute care alternatives, (2) skilled nursing
|
From page 176... ...
It will be important to look at the quality of rehabilitation services provided by subacute care facilities and to compare outcomes for patients treated in subacute care versus conventional inpatient rehabilitation settings. Critical to such a comparison will be adequate control for differences in the casemix of patients treated in alternative settings.
|
From page 177... ...
Lack of Comparison Groups A common methodologic deficiency in rehabilitation services and outcomes research is the infrequent use of comparison groups; the use of randomized controlled trials (RCT) is almost nonexistent.
|
From page 178... ...
Outcomes studies must take a broad perspective in looking at the multiple determinants of recovery so that appropriate interventions can be identified and effectively targeted. A major challenge of rehabilitation services research is defining and improving the interface between the traditional health care system and the social and vocational services system.
|
From page 179... ...
36) points to the lack of this broader perspective as a serious deficit in rehabilitation services research and training: "It fails to impart an adequate understanding of the larger American health care system of which we are all a part.
|
From page 180... ...
These areas are consistent with the research priorities established at a national consensus conference focused on the primary health care needs of people with physical disabilities (Delong et al., 1989; Burns et al., 1990~. Primary Health Care Needs and Impediments to Access to Services First, it is important that a better understanding of the primary health care needs of people with disabling conditions and the barriers that impede access to appropriate services be developed.
|
From page 181... ...
It also happens that primary care providers who are ill-equipped to address the multiple health problems of a person with a disabling condition inappropriately make referrals to multiple specialty care providers, often resulting in delayed treatment and high health care costs (Delong et al., 1989~. More research is needed to define indicators of quality primary health care for people with disabling conditions and the factors that impede access to appropriate use.
|
From page 182... ...
The need for long-term support services to assist people with a disabling condition compensate for a functional limitation is well recognized. These services generally consist of attendant or personal assistance services, assistive technology, as well as institutional care for people with very severe limitations that require daily assistance from medical personnel.
|
From page 183... ...
Similar efforts are needed to assist in the evaluation of personal assistance services (Ratzka, 1986; Nosek, 1993~. Organization and Financing of Primary Health Care and Long-Term Support Services A third critical area for future research pertains to the organization and financing of both primary health care and long-term support services for persons with disabilities.
|
From page 184... ...
It will be important for the field of rehabilitation science and engineering to work closely with health services researchers to proactively evaluate the potential impacts of various models of managed care on access to and use of services, quality of care, costs, and outcomes. The term managed care has been used to describe a diversity of integrated service delivery models proposed as alternatives to the traditional fee-for-service indemnity health insurance plan (Weiner and de Lissovoy, 1993~.
|
From page 185... ...
Some of the critical research questions identified in the report include the following: · What is the impact of different managed care models on access to and use of rehabilitation professionals such as occupational therapy, physical therapy, speech-language therapy, audiology, cognitive therapy, and assistive technologies? If MCO case managers have a good understanding of the service needs and preferences of people with disabling conditions, one can envision systems in which increased access to an appropriate mix of services (i.e., preventive versus curative services and community-based versus institutional care)
|
From page 186... ...
As described above, personal assistance services are critically important to the enabling process. Integrated service delivery models that offer and coordinate long-term care and support services in addition to acute care have the potential of reducing overall health care costs while improving consumer health status and quality of life.
|
From page 187... ...
There is a growing consensus, however, that effective risk adjustment methods must incorporate appropriate measures of functional status to better predict potential resource utilization and costs (Wilkerson et al., 1992; Delong and Sutton, 1994; Heinemann et al., 1994, Stineman, 1995~. In summary, much work is needed to better understand the advantages and disadvantages of various managed care models of service delivery.
|
From page 188... ...
DEVELOPING A HEALTH SERVICES RESEARCH CAPACITY IN REHABILITATION SCIENCE AND ENGINEERING To address the research agenda discussed above adequately, it will be important to develop a stronger HSR capacity in the field of rehabilitation science and engineering. As previously discussed, there is little interaction between traditional rehabilitation researchers on the one hand and health services researchers on the other.
|
From page 189... ...
First, it recommends that transdisciplinary doctoral and postdoctoral training programs be developed in HSR with a concentration in rehabilitation science and engineering. These programs should be designed both for clinicians who require additional training in the issues and techniques of HSR as well as for health services researchers who are interested in applying their knowledge and skills to the study of rehabilitation service delivery.
|
From page 190... ...
· Access to and organization and delivery of services that address the primary health care and long-tenn 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.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.