Large field studies of hospital based services: lessons from occupational therapy

A study with a quasi-experimental design was developed to evaluate the effectiveness of hospital-based occupational therapy services in Nova Scotia. Seven hospitals with occupational therapy services were matched with seven hospitals without occupational therapy services. Within the two hospital groups, subjects were matched on the basis of diagnosis and disability. Outcome measures included measures of functional performance in activities of daily living, and community living skills. This paper discusses some of the strengths and weaknesses of conducting large field studies of hospital based services. It is based on our experience with an occupational therapy outcome evaluation. Some of the strengths include well developed and implemented hospital admission and discharge practices, personal contact with key hospital staff, support of the hospital occupational therapy directors and the Nova Scotia Department of Health, and professional support through national guidelines on the client-centered practice of occupational therapy. Study weaknesses can be categorized into three major areas including evaluation issues, hospital issues, and professional issues. Our experience can contribute to the scientific literature on outcome studies on occupational therapy and to the conduct of large field studies of hospital based services in general.