BOSTON WORKING GROUP ON IMPROVING HEALTH-CARE OUTCOMES THROUGH GERIATRIC REHABILITATION

Geriatric rehabilitation is a multidisciplinary set of evaluative, dia gnostic, and therapeutic interventions whose purpose is to restore fun ctional ability or enhance residual functional capability in elderly p eople with disabling impairments. The Boston Working Group on Improvin g Health Care Outcomes Through Geriatric Rehabilitation was convened t o begin a dialogue among experts in rehabilitation, quality of care, a nd health services research to consider ways to measure, improve, and ensure the quality of geriatric rehabilitation services.The conference centered around four major themes: the definition of disability/disab lement; the patient's experience of rehabilitative care; the role of c linical practice guidelines; and the need for casemix and severity or risk-adjustment procedures and measures. The plenary speaker discussed potential new directions in each of these areas and reviewed the cont ribution of these innovations to improved means of outcomes assessment . Each of the four themes was addressed in the form of a paper by an e xpert in the field. Two reactors with different viewpoints responded t o these papers, and small working groups of participants, convened by topic, contributed to discussions later summarized and presented in pl enary session by a spokesperson for each group. In one small group, tw o reporters represented the majority and minority opinions. A summary speaker presented an overview of the conference deliberations and focu sed on four of the critical points raised by the working groups: (1) t he need to define and describe geriatric rehabilitation in lay terms; (2) the need for more research to link process with outcome; (3) the n eed to balance long-term measurement of process and outcome with short -term analysis that facilitates creative response to accelerating chan ges in the health care sector; and (4) the need to convince a diverse audience of the role of geriatric rehabilitation in providing high qua lity care, good health status, and functional outcomes for older patie nts.