Data Denial: Why the Right Data Is Critical

By Judy Holder, Account Executive, FOTO Analytics, Net Health

On a recent call with a client, I heard a new term: ‘Data denial.’

Even though I hadn’t heard it before, I immediately knew what it meant.  ‘Data denial’ has been the centerpiece of countless discussions for the 25+ years I have worked with clients utilizing a third-party outcomes measurement and reporting system, in this case FOTO. 

What Can Data Denial Tell Us?

Generally, this happens when a therapist is presented with an unfavorable outcome for a patient or a comparison of the aggregated results of patient episodes and responds with disbelief in the results. Maybe you have heard statements like, “you can’t compare my outcomes because I treat the worst patients.”

That is a very reasonable concern.  It makes clinical sense that things like patient age, severity, surgical history, comorbidities, and how long the patient has had the condition they’re being treated for could impact the amount of change that should be expected during a patient episode of care or the number of visits that should yield that expected amount of change.

But are those factors more important than the attitudes and beliefs of the therapist about care?

The finding of the 150^th article published utilizing the FOTO aggregate data was just that.  The research team paired functional status change scores with data from The Attitudes to Back Pain Scale in Musculoskeletal Practitioners Questionnaire to assess the impact. What a relief that FOTO’s comparisons are risk-adjusted by 13 unique risk adjustment factors so that we can eliminate uneven comparisons when studying outcomes. 

It made me wonder what other insights have been gathered through the years. I decided to take a look at the extensive list of articles published using FOTO data. 

I found some interesting insights. 

In one study, the collaborators demonstrated how risk-adjustment models can be developed and the importance of risk-adjustment on provider ranking. In other words, the study shows that unadjusted outcomes end up yielding biased outcomes data and, as a result, incorrect provider ranking.

Another study found that having more interim functional status surveys, especially when the first one was administered early in the episode of care, was associated with better outcomes.  It is very encouraging, for both patients and providers, that utilizing the patient reported outcome to guide and inform treatment early on yields better results. 

It was demonstrated that improvement in Functional Status change can be achieved while reducing rather than increasing number of visits in another research report back in 2014.  Another article demonstrating that the same Functional Status outcomes can be achieved using fewer visits rather than more visits, this time in relation to telerehabilitation, was published in 2022.

Additional screening tools are often beneficial in developing the plan of care for patients.  The examination of which ones are useful – and in what way – is clinically beneficial.  In the case of this study, it was determined that the STarT MSK screening tool may assist therapists in identifying patients who require more intensive care.

The insights into methods to improve care are amplified when patient reported outcomes are combined with treatment data typically housed within an EMR.  In this article the collaborators demonstrated that providing active care and patient compliance with self-exercise drive better outcomes. This was one of the first reports to note that increasing number of visits does not predict better functional outcomes.

So many studies, and there is so much more out there that FOTO data can affect, and we look forward to seeing what researchers find next!

FOTO knows we can’t do it all – and we wouldn’t want to.  The hypotheses are more diverse, and the insights are more meaningful, when we open the door to an unlimited variety of qualified researchers with a simple application process to access de-identified aggregate data.

I am reminded of a quote from Edward Deming – but my actual memory is of Dennis Hart, PhD, PT, FOTO’s original Research Director (and so much more) saying regularly, “In God we trust; all others must bring data.”