The significance of clinical change and clinical change of significance: issues and methods.

The emphasis on systematic methods of demonstrating accountability in health care is affecting the delivery of human services at all levels, from hospitals and community centers to individual private practitioners. New procedures are being proposed to meet the accountability demands encountered by therapists. Several recently developed methods for documenting clinical change in patient status are presented, and the relationship of this documentation to traditional research methods is briefly explored. A clinical illustration of the procedures is provided along with a discussion of advantages and limitations.