Most outcomes researchers address one of two optimization problems: the healthcare macro-systems problem and the consumer-centered problem. Here we focus on the consumer-centered optimization problem. From this perspective, healthcare systems infrastructure can be viewed as imposing a set of temporal, physical and institutional constraints on the viable set of alternative solutions: find the optimal solution for the client, i.e. one which minimizes or maximizes key performance indices, subject to a set of system constraints.

As motivation, one of the overriding recommendations of a recent Falk Workshop on Innovations in Neurorehabilitation was the following carefully crafted statement:

• "Participants felt that technology-assisted rehabilitation tools need to be optimized to address needs of specific patients, but must do so as part of an integrated approach that includes other interventions. .... There are . gaps in knowledge where utilization of technology-assisted rehabilitation tools may be helpful in promoting a paradigm shift:  i) Timing and Intensity.  .;  ii) Components of Therapy.  .; iii) Context/Infrastructure of Healthcare Delivery System. .; iv) Optimizing Delivery Based on Initial and Ongoing Assessment. ..."

The concept of studying outcomes by using the framework of optimization to tie together ideas in healthcare and engineering fields has been suggested. The rationale is that virtually all health professions associated with rehabilitative services have described the aim of rehabilitation as optimizing outcomes through the use of an iterative treatment plan. For instance, consider the following common definitions:

• Outcomes measurement : Systematic observation of outcome indicators
• Outcomes monitoring: Repeated measurement over time of outcome indicators in a manner permitting causal inferences about source of observations
• Outcomes management : Use of information and knowledge gained from outcome monitoring to achieve optimal patient outcomes through improved clinical decision

The rehabilitative process has structural similarities to the classic optimal control and optimal design problems in engineering. Even the terminology is similar. For example, clinical practice guidelines in the allied health professions speak of maximizing function, independence, cost-benefit ratio, quality of life, longevity, participation, satisfaction, etc. (e.g., American Physical Therapy Association, 2001); engineers call these performance criteria. Practitioners use assessment measures such as the Functional Independence Measure at various stages of the plan of care; engineers use such “signals” to help determine optimal control strategies.

For example, occupational therapists identify the key occupational tasks, set treatment goals that optimize performance, and then implement an iterative process aimed at a best outcomes.

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