[Federal Register Volume 62, Number 134 (Monday, July 14, 1997)]
[Notices]
[Pages 37646-37650]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-18418]



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Part II





Department of Education





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National Institute on Disability and Rehabilitation Research; Final 
Funding Priority for Fiscal Years 1997-1998 for a Rehabilitation 
Research and Training Center and Availability of Applications; Notices

  Federal Register / Vol. 62, No. 134 / Monday, July 14, 1997 / 
Notices  

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DEPARTMENT OF EDUCATION

National Institute on Disability and Rehabilitation Research


Final Funding Priority for Fiscal Years 1997-1998 for a 
Rehabilitation Research and Training Center

AGENCY: Department of Education.

ACTION: Notice of a Final Funding Priority for Fiscal Years 1997-1998 
for a Rehabilitation Research and Training Center.

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SUMMARY: The Secretary announces a final funding priority for the 
Rehabilitation Research and Training Center (RRTC) Program under the 
National Institute on Disability and Rehabilitation Research (NIDRR) 
for fiscal years 1997-1998. The Secretary takes this action to focus 
research attention on an area of national need to improve 
rehabilitation services and outcomes for individuals with disabilities, 
and to assist in the solutions to problems encountered by individuals 
with disabilities in their daily activities.

EFFECTIVE DATE: This priority takes effect on August 13, 1997.

FOR FURTHER INFORMATION CONTACT: David Esquith. Telephone: (202) 205-
8801. Individuals who use a telecommunications device for the deaf 
(TDD) may call the TDD number at (202) 205-2742. Internet: 
David__E[email protected]

SUPPLEMENTARY INFORMATION: This notice contains a final priority to 
establish an RRTC for research related to medical rehabilitation 
services and outcomes. This final priority supports the National 
Education Goal that calls for all Americans to possess the knowledge 
and skills necessary to compete in a global economy and exercise the 
rights and responsibilities of citizenship.

    Note: This notice of final priority does not solicit 
applications. A notice inviting applications under this competition 
is published in a separate notice in this issue of the Federal 
Register.

Analysis of Comments and Changes

    On April 21, 1997, the Secretary published a notice of proposed 
priority in the Federal Register (62 FR 19437-19438). The Department of 
Education received 22 letters commenting on the notice of proposed 
priority by the deadline date. Technical and other minor changes--and 
suggested changes the Secretary is not legally authorized to make under 
statutory authority--are not addressed.

Rehabilitation Research and Training Centers

Priority: Medical Rehabilitation Services and Outcomes

    Comment: Three commenters supported maintaining the priority's 
conceptual framework of addressing the topics of medical rehabilitative 
service delivery and functional assessment and outcome measurement in 
one RRTC. Twelve commenters suggested that NIDRR fund two centers 
instead of one. The commenters who supported establishing two centers 
indicated that one center would not be able to organize sufficient 
expertise to address all the priority's purposes adequately and that 
the unique aspects of the two topics require separate research 
activities.

    Discussion: The subject of the priority is improving medical 
rehabilitation services delivery and outcomes. Appropriate use of valid 
functional assessment measures is one important element toward 
improving services as well as justifying the availability, utilization, 
and financing of those services. This is a dynamic field and linking 
the assessment of functional outcomes with the medical rehabilitation 
services in which they will be used, while presenting many challenges 
to the RRTC, reflects the challenges that are occurring in the field of 
medical rehabilitation services.
    RRTCs conduct coordinated and advanced programs of research 
targeted toward the production of new knowledge to improve both 
rehabilitation methodology and services. In this priority, improved 
measurement of outcomes is a vital area of need for methodological 
research. There is a need for improved use of outcome measures to 
assess medical rehabilitation services. The RRTC will need to assemble 
and coordinate the work of experts from diverse fields. While this is a 
demanding undertaking, it is feasible and necessary in order to fulfill 
the purposes of the RRTC. NIDRR emphasizes the importance of involving 
a range of disciplines and collaborative efforts in centers of 
excellence.
    In regard to whether the unique aspects of the two topics require 
separate RRTCs, applicants have the discretion to propose specific 
research and training activities that will define the parameters of the 
RRTC. The priority and application evaluation process are designed to 
provide applicants with the freedom to address unique aspects of one or 
more issues. It is not necessary to establish two RRTCs in order to 
fulfill the purposes of the priority.
    Changes: None.
    Comment: The third purpose should focus on the development and 
validation of methods to evaluate the cost effectiveness and impact on 
functional performance of specific rehabilitation interventions in 
diverse settings and populations. The database elements and standards 
tasks that make-up part of the third purpose are independent of the 
development of measures.

    Discussion: The RRTC is intended to improve rehabilitation services 
and service delivery, applying measures of functional outcomes as a key 
strategy in this endeavor. Uniform database elements and standards are 
prerequisites to implementing any system of functional outcome measures 
in service delivery systems.
    Changes: None.
    Comment: One commenter suggested that methods are needed that will 
provide consumer perspectives on functional abilities and outcomes as 
well as the effectiveness of interventions. The commenter also 
indicated that methods are also needed to support the consumer in 
decision making about interventions including choices about appropriate 
rehabilitation settings and timing of service delivery, accommodations 
in the physical environment, and caregiver assistance options. A second 
commenter suggested that the priority should connect measures of 
specific disabilities or performances with the person's own values and 
perceptions.

    Discussion: All RRTCs are required to involve individuals with 
disabilities and, if appropriate, their family members, as well as 
rehabilitation service providers, in planning and implementing the 
research and training programs, in interpreting and disseminating the 
research findings, and in evaluating the Center. This requirement is 
sufficient to ensure that the RRTC addresses consumer perspectives on 
functional abilities and outcomes, the effectiveness of interventions, 
decision making about interventions, and the connection between 
measures of specific disabilities or performances with the person's own 
values and perceptions.
    Changes: None.
    Comment: The sixth purpose should be deleted from the priority 
because it is substantially different than the priority's main 
emphasis.

    Discussion: The emphasis of the sixth purpose relates to medical 
rehabilitation services system applications. The sixth purpose is 
necessary because it connects the RRTC's work on functional outcome 
measures to applied service settings.

[[Page 37647]]

    Changes: None.
    Comment: The RRTC should establish a health policy research 
fellowship program targeted to people with disabilities seeking to 
become proficient in health policy research at either the masters or 
doctoral level within the context of a university-based degree-granting 
program.

    Discussion: The priority does not provide the RRTC with the 
authority to establish a research fellowship program on the general 
subject of health policy research. An applicant could propose to 
establish a research fellowship program related directly to medical 
rehabilitation services and outcomes. The peer review process will 
evaluate the merit of the proposal.
    Changes: None.
    Comment: Many commenters suggested numerous specific activities for 
the RRTC to carry out. These suggestions include, but are not limited 
to, developing a theoretical or conceptual model of the disablement 
process, establishing an interdisciplinary panel of experts to review 
and author a series of papers summarizing the state of science in their 
area of expertise and disseminate the papers, studying and emphasizing 
the relationship between treatment process to patient outcomes, and 
creating a common metric scale or platform for all functional 
disabilities.

    Discussion: Applicants have the discretion to propose the specific 
activities that the RRTC will undertake in order to fulfill the 
purposes of the RRTC as set forth in the priority. Providing this 
degree of discretion to applicants is an acknowledgement of the wide 
range of approaches that applicants could take. The peer review process 
will determine the merits of the suggested activities.
    Changes: None.
    Comment: The government should insist that any instruments that are 
developed through grant funds are placed in the public domain.

    Discussion: According to the Education Department General 
Administrative Regulations, the Federal government has the right to 
obtain, reproduce, publish, or otherwise use data first produced under 
an award, and authorize others to receive, reproduce, publish, or 
otherwise use these data for Federal purposes. NIDRR is planning to 
convene a public meeting to inform its decision making on this 
important issue as it relates to this and other grants.
    Changes: None.
    Comment: The terms ``rehabilitation centers'' and ``community-
based'' appear in the background statement, but are not defined. It 
would be helpful if they were defined.

    Discussion: These terms, and many others that appear in the 
priority, are not defined in order to provide applicants with the 
option of proposing their own definitions if they consider it 
necessary. The peer review process will determine the merits of any 
proposed definition.
    Changes: None.
    Comment: This Center, and others, should publish their research 
findings in refereed journals.

    Discussion: The quality of an applicant's proposed dissemination 
activities are evaluated in the peer review process using applicable 
selection criteria. No further requirements are necessary.
    Changes: None.
    Comment: The reference to telemedicine and multimedia technology is 
overly prescriptive and should be deleted from the first purpose.

    Discussion: Community-based rehabilitation settings that use 
telemedicine and multimedia technology are increasingly common. If the 
RRTC did not include these settings in their research, the 
applicability of the research that it carries out under the first 
purpose would be significantly restricted.
    Changes: None.
    Comment: The second purpose should be revised to require the RRTC 
to develop and validate measures of social and physical environments, 
and evaluate the ways in which social and physical environments limit 
or enhance the community participation of medical rehabilitation 
service recipients.

    Discussion: The essential difference between the commenter's 
suggestion and the second purpose as set forth in the priority is that 
the commenter's suggestion focuses on the ``community participation'' 
of medical rehabilitation service recipients. An applicant could 
propose to emphasize community participation under the second purpose, 
and the peer review process will evaluate the merits of the emphasis.
    Changes: None.
    Comment: The third purpose should be revised to address evaluation 
activities rather than the development of the database elements and the 
fourth purpose should be revised to address how accrediting bodies can 
serve to enhance routine measurement.

    Discussion: Applicants have the discretion to propose to emphasize 
sundry aspects of a purpose. An applicant could propose to emphasize 
the evaluation components of the third purpose and propose to address 
how accrediting bodies can serve to enhance routine measurement under 
the fourth purpose. The peer review process will evaluate the merits of 
the proposals.
    Changes: None.
    Comment: Four commenters stated that the required purposes under 
the priority did not address sufficiently the problems discussed in the 
background statement related to changes in the organization and 
delivery of medical rehabilitation services. For example, one commenter 
suggested that the RRTC should document trends in the consolidation of 
medical rehabilitation services and evaluate the impact of those 
trends.

    Discussion: NIDRR assumed that these organization and service 
delivery issues would be addressed by applicants under existing 
requirements in the priority. NIDRR agrees with the commenters that the 
priority as written does not ensure that the RRTC will address these 
important topics.
    Changes: A new purpose has been added to the priority that focuses 
on issues of the organization, financing, and delivery of services, the 
impact of managed care on the delivery of medical rehabilitation 
services, consumer access to services, and the capacity of the field of 
medical rehabilitation.
    Comment: Two commenters suggested that the priority should identify 
the most important gaps in current outcome measurement systems and the 
need for better measures or methods of estimation of severity and case 
mix.

    Discussion: Under the first and second purposes, respectively, 
applicants could propose to identify and address the most important 
gaps in current outcome measurement systems and develop better measures 
or methods of estimation of severity and case mix. The peer review 
process will evaluate the merit of the activities.
    Changes: None.
    Comment: It is not necessary to conduct pilot projects in purpose 
four in order to fulfill the purpose's purpose. The RRTC should conduct 
research on obstacles to the use of validated functional outcome 
measures and identify strategies to overcome these obstacles and 
enhance valid use of these measures.

    Discussion: The commenter is correct that pilot projects are not 
the only means that could be used to identify and evaluate strategies 
to evaluate obstacles in the use of validated functional outcome 
measures. Applicants should be given the discretion to propose means to 
evaluate the strategies developed to identify

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obstacles in the use of validated functional outcome measures.
    Changes: The requirement to conduct pilot projects has been 
eliminated from the fourth purpose.
    Comment: Instead of emphasizing the development of strategies for 
determining the long-term results of rehabilitation, the fifth purpose 
should identify factors that affect whether the results of medical 
rehabilitation are sustained in the community over the long term, 
identify linkages between short and long-term outcomes and methods of 
improving and sustaining rehabilitation outcomes in the long term.

    Discussion: There a large number of social, economic, and physical 
factors that could affect whether the results of medical rehabilitation 
are sustained in the community over the long term. The resources that 
would be necessary to properly carry out the commenter's suggestion are 
beyond those that will be provided to the RRTC without significantly 
limiting its capacity to carry out the RRTC's other purposes. An 
applicant could propose to identify linkages between short and long-
term outcomes and methods of improving and sustaining rehabilitation 
outcomes in the long term. The peer review process will evaluate the 
merits of the proposal.
    Changes: None.
    Comment: The RRTC should hold a third conference on the cost-
benefit and cost-effectiveness of medical and vocational 
rehabilitation.

    Discussion: The priority requires the RRTC to support two national 
conferences. An applicant could propose to support additional 
conferences, and the peer review process will evaluate the merits of 
the proposal.
    Changes: None.
    Comment: NIDRR should expand the RRTC to address the rehabilitation 
needs of individuals who are disabled by land mines.

    Discussion: The rehabilitation needs of individuals who are 
disabled by land mines is outside the scope of the priority. In 
developing future priorities, NIDRR will consider the rehabilitation 
needs of individuals who have been disabled by land mines.
    Changes: None.

Rehabilitation Research and Training Centers

    Authority for the RRTC program of NIDRR is contained in section 
204(b)(2) of the Rehabilitation Act of 1973, as amended (29 U.S.C. 760-
762). Under this program the Secretary makes awards to public and 
private organizations, including institutions of higher education and 
Indian tribes or tribal organizations for coordinated research and 
training activities. These entities must be of sufficient size, scope, 
and quality to effectively carry out the activities of the Center in an 
efficient manner consistent with appropriate State and Federal laws. 
They must demonstrate the ability to carry out the training activities 
either directly or through another entity that can provide that 
training.
    The Secretary may make awards for up to 60 months through grants or 
cooperative agreements. The purpose of the awards is for planning and 
conducting research, training, demonstrations, and related activities 
leading to the development of methods, procedures, and devices that 
will benefit individuals with disabilities, especially those with the 
most severe disabilities.
    Under the regulations for this program (see 34 CFR 352.32) the 
Secretary may establish research priorities by reserving funds to 
support particular research activities.

Description of the Rehabilitation Research and Training Center 
Program

    RRTCs are operated in collaboration with institutions of higher 
education or providers of rehabilitation services or other appropriate 
services. RRTCs serve as centers of national excellence and national or 
regional resources for providers and individuals with disabilities and 
the parents, family members, guardians, advocates or authorized 
representatives of the individuals.
    RRTCs conduct coordinated and advanced programs of research in 
rehabilitation targeted toward the production of new knowledge to 
improve rehabilitation methodology and service delivery systems, to 
alleviate or stabilize disabling conditions, and to promote maximum 
social and economic independence of individuals with disabilities.
    RRTCs provide training, including graduate, pre-service, and in-
service training, to assist individuals to more effectively provide 
rehabilitation services. They also provide training including graduate, 
pre-service, and in-service training, for rehabilitation research 
personnel and other rehabilitation personnel.
    RRTCs serve as informational and technical assistance resources to 
providers, individuals with disabilities, and the parents, family 
members, guardians, advocates, or authorized representatives of these 
individuals through conferences, workshops, public education programs, 
in-service training programs and similar activities.
    NIDRR encourages all Centers to involve individuals with 
disabilities and minorities as recipients in research training, as well 
as clinical training.
    Applicants have considerable latitude in proposing the specific 
research and related projects they will undertake to achieve the 
designated outcomes; however, the regulatory selection criteria for the 
program (34 CFR 352.31) state that the Secretary reviews the extent to 
which applicants justify their choice of research projects in terms of 
the relevance to the priority and to the needs of individuals with 
disabilities. The Secretary also reviews the extent to which applicants 
present a scientific methodology that includes reasonable hypotheses, 
methods of data collection and analysis, and a means to evaluate the 
extent to which project objectives have been achieved.
    The Department is particularly interested in ensuring that the 
expenditure of public funds is justified by the execution of intended 
activities and the advancement of knowledge and, thus, has built this 
accountability into the selection criteria. Not later than three years 
after the establishment of any RRTC, NIDRR will conduct one or more 
reviews of the activities and achievements of the Center. In accordance 
with the provisions of 34 CFR 75.253(a), continued funding depends at 
all times on satisfactory performance and accomplishment.
    General: The following requirements will apply to these RRTCs 
pursuant to the priorities unless noted otherwise:
    Each RRTC must conduct an integrated program of research to develop 
solutions to problems confronted by individuals with disabilities.
    Each RRTC must conduct a coordinated and advanced program of 
training in rehabilitation research, including training in research 
methodology and applied research experience, that will contribute to 
the number of qualified researchers working in the area of 
rehabilitation research.
    Each RRTC must disseminate and encourage the use of new 
rehabilitation knowledge. They must publish all materials for 
dissemination or training in alternate formats to make them accessible 
to individuals with a range of disabling conditions.
    Each RRTC must involve individuals with disabilities and, if 
appropriate, their family members, as well as rehabilitation service 
providers, in planning and implementing the research and training 
programs, in interpreting

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and disseminating the research findings, and in evaluating the Center.
    Priorities: Under 34 CFR 75.105(c)(3), the Secretary gives an 
absolute preference to applications that meet one of the following 
priorities. The Secretary will fund under these competitions only 
applications that meets this absolute priority:

Priority: Medical Rehabilitation Services and Outcomes

Background

    Medical rehabilitation services are provided to individuals with 
disabilities to restore maximum function and independence. 
Traditionally, these services were provided by physicians, nurses, and 
allied health professionals in hospitals and rehabilitation centers. 
Medical rehabilitation service consumers comprise a wide range of 
diagnostic groups including individuals with stroke, orthopedic 
conditions, brain injury, spinal injury, and neurologic conditions. The 
need for medical rehabilitation services for persons with disabilities 
is expected to continue to grow in the coming decades because of 
increased chances of survival after trauma, disease, or birth anomaly, 
increased prevalence of disability related to the general aging of the 
population, and the increased incidence of individuals with 
disabilities acquiring secondary disabilities or chronic conditions as 
a result of increased longevity. Despite large growth projections, the 
impact of the projected increase in need for medical rehabilitation has 
not been extensively investigated in relation to long-term costs and 
outcomes.
    Changes in the organization and delivery of health services issues 
are having a significant impact on the delivery and outcomes of 
comprehensive medical rehabilitation services. Recent trends, such as 
decreased length of stay associated with the high costs of inpatient 
care, have contributed to the growth of rehabilitation programs in sub-
acute facilities, such as skilled nursing homes, and increased use of 
outpatient and home health care. Many rehabilitation hospitals, as well 
as medical rehabilitation programs within hospitals, have been 
influenced significantly by program consolidations, changes in 
ownership, third-party reimbursement provisions, and related factors 
that have decreased the number of beds and the average length of 
patient stay. At the same time, demand is increasing for sub-acute 
rehabilitation and general outpatient physical medicine (``Adapting to 
a Managed Care World: The Challenge for Physical Medicine and 
Rehabilitation,'' Lewin-VHI Workforce Study, American Academy of 
Physical Medicine and Rehabilitation, 1995).
    The effectiveness of the treatments and therapeutic interventions 
that are generally used in clinical practice are, for the most part, 
not evaluated in terms of their impact on long-term functional outcomes 
or their cost. The cost-effectiveness and impact of alternative 
rehabilitative strategies should be evaluated rigorously in order to 
obtain information that will contribute to cost-effective, rational, 
and fair decisions regarding the provision of treatment and services. 
Medical rehabilitation services need an enhanced validated outcome 
measurement system to inform decisions in management issues facing 
health care consumers, providers, and insurers. Increasingly, payers 
are seeking to base decisions of whether to provide coverage for 
selected services or interventions on the basis of proven efficacy or 
cost-effectiveness as determined by rigorous scientific evidence such 
as that gained through randomized controlled trials.
    Functional Assessments (FAs) can be used to evaluate an 
individual's ability to carry out activities of daily living and 
instrumental activities of daily living such as eating, bathing, moving 
from place to place, dressing, doing household chores or other 
necessary business, and taking care of personal hygiene. Data from FAs 
also are used to predict post-rehabilitation functioning, and to 
evaluate rehabilitation services. Improving rehabilitation practices 
and outcomes requires an ability to assess the status and changes in 
function in many areas. Multiple measures of function and activities of 
daily living are needed in all rehabilitation settings, including in 
the home and community. The increased use of telemedicine and 
multimedia technology is rapidly changing the manner in which 
functional assessment measures are generated and shared among members 
of the rehabilitation team. Functional outcome measures are of 
increasing importance in medical economics, benefits planning, managed 
care, and program evaluation (Ikegami, N., ``Functional Assessment and 
Its Place in Health Care,'' New England Journal of Medicine, Vol. 332, 
pgs. 598-599, 1995).
    There is a need to collect and analyze data to determine the 
organization and delivery of rehabilitative care, including parameters 
such as facility and program sizes (i.e., economies of scale) and the 
number and mix of health care providers needed to serve various 
disability groups. Few data are available to define optimal strategies 
for outpatient services, nor are there methods to apply FAs or gather 
patient outcome data in non-hospital settings.
    Improving rehabilitation medicine and ensuring that disabled 
individuals will have access to needed medical rehabilitation in the 
future requires: an ability to assess functional status and changes in 
status in many functional areas; the ability to evaluate rehabilitation 
outcomes for individuals with various diagnoses, characteristics, and 
interventions; and the ability to apply these measures in health 
services policy research in order to affect policy and funding 
decisions in the health care delivery context.
    In the past, NIDRR has supported the development and application of 
the ``Functional Independence Measure'' (FIM), a criterion-referenced 
scale that has been widely accepted in inpatient rehabilitation 
settings, and also the development of the ``Craig Handicap Assessment 
and Reporting Technique'' (CHART), which contains scales for assessing 
the World Health Organization (WHO) dimensions of handicap, and is 
currently being refined to measure cognitive components of handicap. 
NIDRR currently supports an RRTC on Functional Assessment that has 
contributed to the scientific measurement of medical rehabilitation 
through applications of the FIM, refinement of the CHART, and 
management and analysis of the Uniform Data System (UDS), a collection 
of data from the application of FIM measures in many institutions.
    Current measurement systems, such as the FIM and the UDS, have made 
significant contributions, but need modifications to increase their 
utility and applicability in the new environment of rehabilitation 
care. For example, many practitioners and theorists have suggested that 
the FIM does not make adequate provision for the role of assistive 
technology in attaining functional levels. Like the FIM, most 
functional assessment measurement systems were designed for use in an 
inpatient setting. These systems need to be evaluated and modified to 
measure functional status and functional change outside of hospital and 
clinical settings, either in community-based facilities or in real-
world environments of daily living. The FIM, for example, needs further 
refinement to address the social and environmental dimensions of 
disablement. The UDS at present contains data on a limited number of 
disabilities, and those measurements again are not community-based.

[[Page 37650]]

    NIDRR also has supported a center on medical rehabilitation 
services that has looked at factors such as supply and demand for 
rehabilitation facilities and practitioners, financing, and evaluation 
of the outcomes of rehabilitation medicine. This center has also 
addressed the changing context for the delivery of medical 
rehabilitation and access to medical rehabilitation by various 
population groups. Both of these centers have made contributions to the 
maturing of the field of medical rehabilitation and its ability to 
evaluate and document its interventions and outcomes.
    However, it is now clear that the field needs a larger and more 
integrated effort to refine measures of functional ability, changes in 
ability over the lifespan or in response to medical rehabilitation 
interventions, and to apply the measurement system in the changing 
environment in which medical rehabilitation is delivered. NIDRR 
therefore is proposing a large-scale effort to involve significant 
leaders in the classification and measurement of function, the 
evaluation of rehabilitation interventions, and the broader application 
of knowledge to the organization and management of medical 
rehabilitation services in today's environment.
    Priority: The Secretary will establish an RRTC for the purpose of 
examining the impact of changes in the field of rehabilitation medicine 
and developing improved measures for assessing individual function and 
the impact of medical rehabilitation services. The RRTC shall:
    (1) Identify and evaluate validated functional outcome measures 
that can be used or modified for assessing the impact of medical 
rehabilitation services in a wide range of rehabilitation settings, 
with particular emphasis on measures that can be adapted for use in 
outpatient and community-based settings, including those that use 
telemedicine and multimedia technology;
    (2) Develop or improve measures to assess the impact of the social 
and physical environment in achieving quality rehabilitation outcomes, 
including the use of assistive technology in attaining functional 
outcomes; (3) Identify or develop uniform database elements and 
standards based on validated individual measures at the person level 
for determining the cost-effectiveness and functional impact of 
specific rehabilitation interventions used by medical rehabilitation 
and allied-health disciplines across multiple settings and disability 
populations;
    (4) Identify obstacles to the use of validated functional outcomes 
measures in a wide range of settings in which medical rehabilitation 
services are provided, and in decisions to provide and assess the 
effectiveness of medical rehabilitation treatments, and develop and 
evaluate strategies to overcome those obstacles;
    (5) Identify strategies for determining the long-term results of 
medical rehabilitation care, including use of assistive technology;
    (6) Analyze how models for the organization of medical 
rehabilitation services affect outcomes and costs, and how the 
demographic, economic, and presenting conditions of consumers affect 
their utilization of rehabilitation services and the outcomes that are 
achieved;
    (7) Analyze the impact of new configurations of medical 
rehabilitation service delivery and financing, such as capitated 
managed care and risk adjustment strategies, on access to quality 
medical rehabilitation services; and
    (8) Develop an information dissemination and training program to 
enable consumers, providers, researchers, policy makers, and relevant 
others in health and rehabilitation settings to assess the quality of 
medical rehabilitation services.
    In carrying out the purposes of the priority, the RRTC shall:
     Coordinate with rehabilitation medicine research and 
demonstration activities sponsored by NIDRR, including the RRTC on 
Health Care for Individuals with Disabilities--Issues in Managed Health 
Care, the National Center on Medical Rehabilitation Research, Veterans 
Administration, and the Health Care Financing Administration; and
     Support two national conferences as follows: (1) a 
conference on the use of functional outcome measures to improve medical 
rehabilitation practices and interventions, and (2) a conference on 
improving validity and reliability in the measurement of rehabilitation 
outcomes.
    Applicable Program Regulations: 34 CFR Parts 350 and 352.

    Program Authority: 29 U.S.C. 760-762.

(Catalog of Federal Domestic Assistance Numbers: 84.133B, 
Rehabilitation Research and Training Center Program)

    Dated: July 9, 1997.
Judith E. Heumann,
Assistant Secretary for Special Education and Rehabilitative Services.
[FR Doc. 97-18418 Filed 7-11-97; 8:45 am]
BILLING CODE 4000-01-P