CAN WE ACHIEVE ACCOUNTABILITY FOR LONG-TERM OUTCOMES

Objective: To explore options for the development of a set of indicato rs to assess the long-term outcomes achieved by all people with a give n disabling condition in a given population. Data Sources: The review draws on empirical studies of predictive indicators, theoretical liter ature on long-term recovery processes, and literature from administrat ive science on the use of indicators in accountability systems. Study Selection: Studies were selected that explicitly sought to relate shor t-term and long-term outcomes or that explored the mediating factors i n the relationship between impairment, disability, and handicap. Data Extraction: The focus of the review is on (1) empirical evidence of th e relationship between short- and long-term outcomes, particularly in causal claims, and (2) theoretical analyses of the factors that mediat e this relationship. Data Synthesis: Evidence is presented that certai n outcome states can be considered thresholds that make the outcome us able and, hence, sustainable or that create the opportunity for furthe r improvement. Such thresholds could meet the construct validity crite ria necessary for measures that are to be used as indicators in an acc ountability system. The interaction between psychological and physical factors in setting thresholds means that both objective and subjectiv e indicators are required in an indicator system. Conclusions: It may well be possible to develop a parsimonious set of population-based out come indicators for people with disabilities. The key safeguards requi red are construct validity and the involvement of people with disabili ties in both the development and use of the indicators. (C) 1996 by th e American Congress of Rehabilitation Medicine and the American Academ y of Physical Medicine and Rehabilitation.