Initiatives in rehabilitation research.

Federal funding of rehabilitation research depends on how much that research is valued, both within the physical therapy profession and among the external groups and individuals who have a stake in the research outcomes. To help advance rehabilitation research, the American Physical Therapy Association (APTA) forges partnerships, coalitions, and collaborations for advocacy, awareness, and legislative action; promotes the appointment of physical therapists to federal panels; and fosters infrastructure and research capacity building. To further cement the physical therapy profession's relationship with policymakers, APTA also is identifying health policy questions.

Health Services Research Agenda

APTA's efforts to increase physical therapists' visibility within the research environment primarily involve collaborating with program officers at the National Institutes of Health (NIH) and those rehabilitation researchers who request funding from the NIH. Another important activity is promoting the importance of health services research to physical therapists. Health services research is a diverse area that includes health care economists, political scientists, and physicians and other health care providers. Although relatively new, this field continues to grow in importance as the proportion of the gross national product attributed to health care costs continues to increase.

Health services research attempts to answer questions that essentially have to do with access to and the quality and cost of health care as well as the supply of and demand for providers of health services. The Agency for Healthcare Research and Quality (AHRQ) provides the following definition of health services research:

   Health services research examines
   how people get access to health care,
   how much care costs, and what happens
   to patients as a result of this
   care. The main goals of health services
   research are to identify the
   most effective ways to organize, manage,
   finance, and deliver high quality
   care; reduce medical errors; and
   improve patient safety. (1)

With a nod to Vision 2020, APTA's Advisory Panel on Research (APOR) has identified the 4 "Bs" of research as bench, bedside, boardroom, and bureaucracy ([B.sup.4]2020). "Bedside" refers to clinical research and clearly asks questions about the quality of physical therapy services; "boardroom" and "bureaucracy" are related to cost-effectiveness considerations and policy issues, two topics clearly subsumed within health services research.

As part of its rehabilitation research initiative, APTA is devoting substantially more attention to health services research. In October 2005, a task force of 7 physical therapists and APTA staff will participate in a meeting focused on health services research. The formation of the task force grew out of APTA's experience with the Medicare Payment Advisory Commission (MedPAC), which studied the advisability and feasibility of allowing patients receiving Medicare direct access to physical therapy as part of the Medicare Prescription Drug and Modernization Act. The commissioners recommended that the referral requirement should be retained due to concerns about utilization and costs. Unfortunately, APTA had limited empirical information to counter this decision.

The goal of the upcoming meeting, therefore, is to develop a series of health policy research questions and potential funding sources for the research needed to answer the questions. The agenda for the task force will not be restricted to direct access, but will include the entire scope of health services research and its impact on rehabilitation and physical therapy. The group will identify policy issues that must be addressed to advance rehabilitation science and physical therapy. Thus, APTA will be taking a more proactive stance in the health services research/policy arena. Each of the task force participants has a background in health services research and maintains a collegial relationship with leaders in the field. A number of these individuals received graduate school training in a specific discipline subsumed under health services research.

An officer of AcademyHealth, the foremost organization that deals with the various aspects of health services research, also will attend the meeting. Her role will be to inform task force members about which of the identified questions have the optimal chance of being funded by an external organization. Because the spectrum of potential questions is so broad, those that are most likely to be funded will be the ones that will be accorded the highest priority for the Association.

Those activities that will inform policy will be shared with additional communities of interest, both within and outside APTA. Two presentations for APTA membership have already been scheduled. The Health Policy and Administration Section is sponsoring a presentation at the 2006 Combined Sections Meeting in San Diego to update members on the progress that the task force makes at the October meeting. In addition, task force members have already been given dedicated time at annual conference in Orlando to present on a health services research topic--most likely the importance of cost-effectiveness studies to the physical therapy profession. Finally, it is anticipated that the task force will be expanded next year to include leaders in the health services research field. The role of these individuals will be to comment on the policy questions that the task force formulated. An adjunct benefit of the expansion is increased visibility for physical therapy among this leadership group.

Questions about APTA's initiatives in rehabilitation research may be directed to [e-mail].

References

(1) What is health services research? Academy Health Web site. Available at: www. academyhealth.org/about/whatishsr.htm. Accessed August 8, 2005.

APTA's recognition of the importance of health services research is exemplified by its use of [B.sup.4]2020 to describe the research continuum.