The core principles driving the research team relate directly to FOTO’s purpose, which is to provide reliable, valid and responsive outcomes measures and aggregate data management services to enable real-time information that empowers clinicians, patients, payers, policy makers, and facilitates choice, delivery and payment based on the most effective rehabilitation therapy.

To accomplish FOTO’s purpose, the research team has been active since 1992 analyzing the data collected during every day outpatient rehabilitation. (Published Paper) Our research represents effectiveness research, which by definition addresses the questions confronting clinicians and patients daily:

·        What works

·        What works for which patients

·        How can we improve our understanding of patient outcomes

·        How can we apply our knowledge of effectiveness research

·        How can we balance effectiveness with efficiency

Our purpose driven research efforts imply our products are evolving constantly as we understand our research results tempered by policies impacting clinical practice.

To address “What works”, we need to know did the patient get better. This means we need outcomes measures that are reliable, valid and responsive. We continuously investigate the measures we collect on patients. (Reference) Current measurement efforts are driven by Item Response Theory (Reference) methods and Computerized Adaptive Testing (CAT Central) because many believe IRT and CAT will be the future of patient-self report of functional status. Research findings from the FOTO team have supported this belief. (Reference) (Reference) (Reference) Hence, the research team is developing body part specific CATs because results support the psychometrics and efficiency of the CATs.

To address “What works for which patients”, the research team is studying patient classification procedures that have been shown to successfully classify patients into clinically meaningful homogeneous subgroups. Such classification allows clinicians to direct treatment designed to produce better outcomes for patients managed with prescriptive treatments and to improve prediction of outcomes.
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To address “How can we improve our understanding of patient outcomes”, the research team is investigating sophisticated statistical risk-adjustment techniques. The risk-adjustment techniques improve our understanding of patient outcomes and allow more meaningful interpretations of the research results. (Reference)

To address “How can we apply our knowledge of effectiveness research”, the research team in conjunction with our Providers Relations Department continuously update the way clinicians’ outcomes are reported. Our outcomes reports now include risk-adjusted data, which allows more meaningful interpretations of benchmarked data. Reports also identify measurement change that was greater than measurement error. (FOTO Reports)

To address “How can we balance effectiveness with efficiency”, our research team is investigating pay-for-performance (i.e., value-based purchasing) methods of reimbursement. In a P4P payment process, risk-adjusted functional status change (i.e., effectiveness) is matched to the number of visits used (i.e., efficiency). In this way, providers who gain greater than expected outcomes using fewer than expected visits will be identified for higher reimbursements. In this way, the research team is involved in the evolution of the medical delivery system, which is progressing towards the Institute of Medicine’s vision of the future where clinical services will be safe, effective, patient-centered, timely, efficient, and equitable.

FOTO has a reputation of collaborating with interested, experienced researchers. If you would like to collaborate with us, please contact Dr. Dennis L. Hart, PhD, PT, Direct of Consulting and Research (hart@fotoinc.com).