Postacute Rehabilitation Research and Policy Recommendations

doi:10.1016/j.apmr.2007.07.022

Archives of Physical Medicine and Rehabilitation

Volume 88, Issue 11, November 2007, Pages 1535-1541

https://doi.org/10.1016/j.apmr.2007.07.022 Get rights and content

Abstract

Clohan DB, Durkin EM, Hammel J, Murray P, Whyte J, Dijkers M, Gans BM, Graves DE, Heinemann AW, Worsowicz G. Postacute rehabilitation research and policy recommendations.

This article summarizes the research and health policy recommendations developed by participants at the symposium “State-of-the-Science on Post-Acute Rehabilitation: Setting a Research Agenda and Developing an Evidence Base for Practice and Public Policy,” held in February 2007. A diverse group of participants represented federal government agencies, private insurers, professional organizations, providers of rehabilitation services, patients and their advocates, and health researchers. During roundtable discussions and theme-specific break-out sessions, participants were asked to consider 5 major topics regarding postacute rehabilitation care: (1) the extent of our knowledge, (2) the limitations of our knowledge, (3) the barriers that limit research, (4) research priorities to reduce these obstacles and assemble needed evidence, and (5) the major policy implications. Several key themes emerged: the need for improved measures, particularly of case-mix factors and treatment ingredients; the need for a more uniform and coherent system of postacute rehabilitation care to facilitate gathering of common data; the need to attend to underutilization as well as overutilization of rehabilitation services; the need for cooperation among payers, providers, and researchers to advance a rehabilitation effectiveness research agenda; and the desire to develop payment policies that are based on research evidence.

Section snippets

Track 1: Measurement and Methodology Recommendations

The measurement track participants developed recommendations regarding a wide range of questions, a subset of which included:

1
What PAC outcomes should be measured short- and long-term?
2
What are the strengths and weaknesses of each current PAC assessment instrument?
3
Is a unified postacute rehabilitation care assessment tool feasible?
4
What case-mix adjustment methodologies may be used to compare outcomes across different PAC sites?

Track 2: Access to Postacute Rehabilitation Services

Making access to postacute rehabilitation a priority topic in a research symposium signals the need for answers to several questions, including:

1
Why are there variations in PAC rehabilitation utilization related to sex, race, and ethnicity, age, socioeconomic status, and geographic location?
2
Are differences in access the same phenomenon as disparities?
3
Would eliminating variations in access improve outcomes?

Track 3: Organization of PAC Rehabilitation Services

In the symposium’s third track, participants examined the state of knowledge regarding the organization and delivery of rehabilitation services across multiple settings. Discussion focused on 2 areas of inquiry. The first was variation in the organization of rehabilitation services across the 4 PAC settings (HHAa, SNFs, IRFs, LTCHs), primarily in terms of process. Questions included:

1
What do we know about how these sites differ in terms of intensity and duration of services?
2
What do we know about

Track 4: Effectiveness of Postacute Rehabilitation

Discussions in this track highlighted the distinction between efficacy (eg, effect of an intervention in a controlled trial) and effectiveness studies (eg, effect of an intervention in clinical settings). Participants addressed the following questions.

1
For what questions and under what circumstances would different designs be most appropriate for demonstrating treatment effectiveness?
2
How do we ensure that case mix has been adequately adjusted in quasi-experimental designs?
3
How should we design

Conclusions

Several key themes emerged from the discussions and recommendations of all groups.

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: Supported in part by the National Institute on Disability and Rehabilitation Research through the Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness (grant no. H133B040032).

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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Special sectionSpecial communicationPostacute Rehabilitation Research and Policy Recommendations

Abstract

Section snippets

Track 1: Measurement and Methodology Recommendations

Track 2: Access to Postacute Rehabilitation Services

Track 3: Organization of PAC Rehabilitation Services

Track 4: Effectiveness of Postacute Rehabilitation

Conclusions

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

International classification of functioning, disability and health: ICF

Management of adult stroke rehabilitation care: a clinical practice guideline

Stroke

Pressure ulcer: the management of pressure ulcers in primary and secondary care

NICE pressure ulcer guideline: summary and implications for practice

Br J Community Nurs

Evaluating the quality of medical care. 1966

Milbank Q

Special section
Special communication
Postacute Rehabilitation Research and Policy Recommendations