AJOT publication priorities.

Recently, the Institute of Medicine (Eden, Wheatley, McNeil, & Sox, 2008; Sox & Greenfield, 2009) publicly called for increased effectiveness research to determine the most effective and cost-efficient health care methods. This mandate corresponds to the American Occupational Therapy Association’s Centennial Vision (AOTA, 2007), in which the profession is exhorted to demonstrate through research that its services effectively help people maintain participation in work, school, and family and community roles despite illness, injury, or disability. Occupational therapy scholars have called for effectiveness and efficiency research for more than two decades (e.g., Baum, 2006; Case-Smith & Powell, 2008; Christiansen, 1983; Corcoran, 2004; Holm, 2000; Kielhofner, Hammel, Finlayson, Helfrich, & Taylor, 2004; Law, 2002; Mosey, 1996; Moyers, 2007). In this article, effectiveness is defined as an examination of practice to determine whether and how well a specific intervention works as intended. Efficiency is defined as an examination of practice to determine matters such as cost and time efficiency, safety, patient satisfaction, and patient adherence. As a health care profession, occupational therapy has an inherent obligation to demonstrate to society that its services are effective and safe. In today’s era of health care, managed care representatives have usurped the decision-making role from health care providers (including occupational therapists) and now oversee critical decisions, such as who receives treatment, when treatment begins and ends, how often treatment is provided, and whether service reimbursement will be denied or approved (Mariner, 2000;Mattke, Seid,&Ma, 2007; Willmarth, 2005). This situation has arisen largely because, as a profession, occupational therapy (like many other health care professions) has not answered questions about treatment effectiveness and efficiency though empirical research. Without research demonstrating the effectiveness of occupational therapy interventions with specific clinical populations, occupational therapy has enabled third-party payers to decide who receives which interventions and at what time in the rehabilitation course. A body of research documenting effectiveness and efficiency is needed to provide the profession with leverage to dispute adverse third-party payer decisions and to ensure that occupational therapists are not cut from insurer and legislator lists of approved providers.