Should occupational therapy choose a single functional outcome measure?

Presently in rehabilitation, functional measures arrear to have an unmatched ropularity, both in terms of outcome research and in the develormem of a prospeerive payment system. Outcome research in rehabilitation, which undoubtedly includes the use of funerional measures, has become a rriority for man)' rehabilitation organizations The rress for this research is being fueled by the prospect of health care reform, which is likely to limit the type of services offered and the extent to which services are covered. Evidence of successful and efficient functional outcomes is exrected to be the major mechanism b)' which organizations will convince third-pany pa)'ers to cover services. The imponance of functional measures is also reflected in a Congressional mandate to develor a Medicare rehabilitation rayment system (Deparlmelll of Health and Human Services, 1987). Several studies have shown that a diagnoSis-related grour (DRG) basis is inaprropriate for a rrospective payment system for rehabilitation (llosek et aI., 1986; McGinnis, Osberg, Dejong, Seward, & Branch, 1987; Rondinelli, Murphy, Wilson, & Miller, 1991), and there appears to be consensus that functional measures will serve as more arrropriate indicators for such a system (Wilkerson, Batavia, & Dejong, 1992). In contrast to DRGs, functional measures arc more consistent with the goals of rehabilitation and appear to be good predictors of rehabilitation resource use, at least for inratient rehabilitation (Hosek et aI., 1986; McGinnis et aI., 1987; National Association of Rehabilitation Facilities, 198';) . A proposed mechanism to facilitate outcome reseal-ch in occurational therapy and to be consistent with a future rrosrective payment system is the adoption of a single functional outcome measure. The use of one functional Craig A Velozo