The effect of changes in the health care environment on rehabilitation research: A survey of rehabilitation physicians

Objective: To assess what effect organizational, funding, and system change s in the health care environment may have on rehabilitation research. Design: National survey. Setting: Academic and clinical research programs. Participants: A total of 138 physicians participated in the survey. Intervention: Mailed instrument requesting information on demographics, res earch activities, and indicators of change. Main Outcome Measures: Percentage of respondents reporting specific percept ions on (1) how academic and research programs are affected by organization al changes, (2) availability of research funds, and (3) the overall impact that health care changes have on research; between-group comparisons on sur vey responses. Results: Usable responses were obtained from 138 physicians (response rate, 42.5%). Responding physicians reported workplace changes that included org anizational restructuring (32.6%), affiliation with managed care plans (24% ), and staff decreases (45.9%). Over half (54.8%) indicated that facility c hanges had detracted from their abilities to conduct research. A third (34. 8%) reported declines in numbers of inpatient beds, and 89.6% reported decr eased length of stay (LOS). Decreased LOS was cited as detracting from ongo ing research by 36.6% and as discouraging new research by 33.3% of responde nts, Although not reflected in measures of scholarly productivity, 53.6% re ported having less time to devote to scholarship and 48.5% reported decreas ed professional activities. Over two thirds (67.4%) of responding physician s indicated that health care system changes had a negative impact on curren t research, and 54.5% indicated that such changes made it less likely that they would pursue new research. Conclusion: Changes in the health care system have had a dampening effect o n rehabilitation physicians' research pursuits.