Johnston M V, Hall K M
Kessler Institute for Rehabilitation, East and West Orange, NJ 07052.
Arch Phys Med Rehabil. 1994 Dec;75(12 Spec No):SC1-9; discussion SC27-8.
Questions of how to measure outcomes are commonly heard in rehabilitation today. In this supplement we review the current state of the art of outcomes measurement in traumatic brain injury rehabilitation, discuss key issues, and identify steps that need to be taken. The underlying question is not simply that of outcomes measurement but how to infer effective and cost-effective treatment. The validity of such inferences rests on multiple features of the entire clinical information system. Requirements for valid, feasible, outcome-oriented clinical data systems are described. Effectiveness is inferred from variations in outcomes experienced by similar persons who received differing interventions. Outcome data systems need large sample sizes and technically adequate severity adjusters. A nationwide TBI data system is needed to identify reasonably homogeneous subgroups in different programs whose outcomes can be meaningfully compared. In alliance with payors and persons with disabilities, rehabilitation professionals can create outcome data systems that will provide the knowledge necessary to improve the effectiveness and cost-effectiveness of rehabilitation programs.
如今，在康复领域，关于如何衡量治疗效果的问题屡见不鲜。在本增刊中，我们回顾了创伤性脑损伤康复中疗效评估的当前技术水平，讨论了关键问题，并确定了需要采取的步骤。根本问题不仅仅是疗效评估，而是如何推断有效且具有成本效益的治疗方法。此类推断的有效性取决于整个临床信息系统的多个特征。描述了对有效、可行、以结果为导向的临床数据系统的要求。有效性是从接受不同干预的相似个体所经历的治疗效果差异中推断出来的。疗效数据系统需要大样本量和技术上足够的严重程度调整指标。需要一个全国性的创伤性脑损伤数据系统，以识别不同项目中合理同质的亚组，其治疗效果可以进行有意义的比较。康复专业人员与付款人和残疾人联合起来，可以创建疗效数据系统，这些系统将提供提高康复项目有效性和成本效益所需的知识。
