The continuing rise in health care costs is a cause for growing concern in Europe. As a consequence of demographic developments and improvements in medical care, pressure on health care resources is increasing. This forces the development of systems and tools for accountability, quality of care and efficiency. A key element in this is the development of adequate outcome instruments. In recent years numerous outcome measures have become available in medical care e.g. generic and disease specific measures of health related quality of life and physical health status. Surprisingly, European efforts to harmonize assessment tools have been restricted to the fields of epidemiological and clinical research. Rehabilitation focuses on minimalisation of the functional limitations of patients in situations where the underlying impairments cannot be reversed, and/or improvement of patients' lives or decreasing handicap (NIH, 1993; Johnston et al. 1993). Additionally to available outcome instruments in medical care, rehabilitation assessment includes measures of mental impairment (e.g. cognitive tests), physical disabilities (e.g. gait analysis) and vocational behaviour (e.g. functional capacity evaluation).
At the European level, collaboration in rehabilitation research is needed to exchange experiences and to build a common body of knowledge on rehabilitation outcome measurements. This project is a concerted action of which the potential value is the avoidance of duplication of activities, particularly in the development of measures, common methodologies for assessing outcomes, deepening understanding in applying measures within rehabilitation practice, and improving transnational data-exchange and discussion on quality of care.
The specific objectives of the ACROSS-project include:
1. A joint review of the state of the art of rehabilitation outcome measures used in the participating countries, including information on characteristics of patients, rehabilitation settings and interventions;
2. The development of common standardized rehabilitation outcome measures, including the production of different lingual versions of measures;
3. Testing the feasibility and psychometric properties of the adapted measures;
4. Combination of data from different centres in order to analyse discrepancies in data and to identify characteristics that might explain them;
5. Dissemination of results and enhancement of rehabilitation outcome research at a European scale.
KEYWORDS: Rehabilitation, impairment, disability, outcome-assessment, quality of care, measures of health, functional status, cross-cultural instruments, programme evaluation.05 05