The Effect of Changes in the Health Care Environment on Rehabilitation Research: A Survey of Rehabilitation Physicians Quentin W. Smith, MS, J. David Holcomb, EdD, Jan Galvin, CF, Gerben DeJong, PhD, Joel A. DeLisa, MD, MS, J. Kyle Roberts, PhD ABSTRACT. Smith QW, Holcomb JD, Galvin J, DeJong G, DeLisa JA, Roberts JK. The effect of changes in the health care environment on rehabilitation research: a survey of rehabilitation physicians. Arch Phys Med Rehabil 2001;82: 1624-9. Objective: To assess what effect organizational, funding, and system changes 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, research activities, and indicators of change. Main Outcome Measures: Percentage of respondents re- porting specific perceptions on (1) how academic and research programs are affected by organizational changes, (2) availabil- ity 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 physi- cians (response rate, 42.5%). Responding physicians reported workplace changes that included organizational restructuring (32.6%), affiliation with managed care plans (24%), and staff decreases (45.9%). Over half (54.8%) indicated that facility changes had detracted from their abilities to conduct research. A third (34.8%) reported declines in numbers of inpatient beds, and 89.6% reported decreased length of stay (LOS). Decreased LOS was cited as detracting from ongoing research by 36.6% and as discouraging new research by 33.3% of respondents. Although not reflected in measures of scholarly productivity, 53.6% reported having less time to devote to scholarship and 48.5% reported decreased professional activities. Over two thirds (67.4%) of responding physicians indicated that health care system changes had a negative impact on current 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 on rehabilitation physicians’ research pur- suits. Key Words: Managed care programs; Rehabilitation; Re- search. © 2001 by the American Congress of Rehabilitation Medi- cine and the American Academy of Physical Medicine and Rehabilitation B ECAUSE PURCHASERS OF HEALTH care services, particularly employers who provide health care coverage for workers, have become increasingly interested in containing the spiraling costs of health care, more Americans find them- selves enrolled in managed care plans. The phenomenal growth of managed care over the last quarter of the 20th century has been documented in the literature. In 1980, there were 236 health maintenance organizations (HMOs) in the United States, enrolling 9.1 million Americans. 1 By 1995, the number of HMOs had nearly tripled to 674, whereas the number of people enrolled under these plans had increased more than sixfold to 59.1 million. 1 Managed Care On-Line 2 reported that, in 1999, a total of 181.4 million Americans (67.1% of a total population esti- mated at 270.3 million) were enrolled in managed care plans. This total included 79.3 million in HMOs, 89.1 million in preferred provider organizations, and 13 million in exclusive provider organizations. 2 Managed care organizations (MCOs) are now the predominant health care delivery model in the United States. In fact, enrollment in indemnity health care plans, which for decades had dominated American health care, has declined dramatically in recent years, accounting for only slightly more than 10% of employees with employer-sponsored health insurance in 1998, compared with nearly 40% of such individuals in 1994. 3 THE IMPACT OF HEALTH CARE RESTRUCTURING ON BIOMEDICAL RESEARCH Although many view the growth of managed care as primar- ily affecting quantity and quality of care for covered individ- uals (eg, shorter lengths of stay [LOSs] in hospitals, fewer referrals to physician specialists), there is a growing body of literature on the impact that managed care has had on clinical research. A preliminary investigation by Mechanic et al 4 sug- gested that the nation’s academic medical centers were likely to be affected significantly by the growth of managed care enroll- ment. They reported that the academic centers would come under financial pressures as MCOs sought to reduce “cross- subsidies” that historically were used to support medical edu- cation and clinical research activities. 4 Results from other investigations 5,6 suggest that faculty in highly competitive health care markets in which MCOs have made more signifi- cant inroads may experience lower research productivity and less success in obtaining research grants. The factors that contribute to health care restructuring and their impact on biomedical research must be considered beyond the issues of faculty time and service reimbursement. With the From the Departments of Family and Community Medicine (Smith, Holcomb) and Physical Medicine and Rehabilitation (Smith), Center for Educational Outreach (Roberts), Baylor College of Medicine, Houston, TX; The Galvin Group, Tucson, AZ (Galvin); National Rehabilitation Hospital Research Center, Washington, DC (De- Jong); Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, West Orange, NJ (DeLisa); and Kessler Rehabilitation Research and Education Corp, West Orange, NJ (DeLisa). Accepted in revised form January 30, 2001. Supported by the National Institute on Disability and Rehabilitation Research. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Reprint requests to J. David Holcomb, EdD, Div of Allied Health Sciences, Rm 633E, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, e-mail: jholcomb@bcm.tmc.edu. 0003-9993/01/8211-6542$35.00/0 doi:10.1053/apmr.2001.26623 1624 Arch Phys Med Rehabil Vol 82, November 2001