Four Reasons Why Patients Deserve ADTO

Although we probably already have enough "models of care" to last a lifetime, I think we would do well to focus on one simple abbreviation: ADTO, or Assessment-Diagnosis-Treatment-Outcome. This model could, quite simply, save millions if not billions of dollars for health care consumers. But before it can do so, it needs to become a foundation for researchers, clinicians, and patients alike.

Across the continuum of health care, our goal as clinicians should be reliability, consistency and reproducibility. There should be a scientific method-based foundation for health care. But even if we have this, patients need to also have it as their accepted community standard of care.

So what does ADTO mean to patients? And why is it important?

Each one of the "steps" in ADTO is critical from the perspective of the patient – and the scientific method as a whole.

1. Assessment - Diagnosis: The clinical care process starts with assessment. A clinician must be able to have highly reliable assessment tools to allow multiple clinicians to agree on a consistent diagnosis. If inter-rater reliability doesn't exist, then it is pretty hard to imagine the assessment having much validity in the process. With that in mind, a diagnostic classification system based on assessment tools having good inter-rater reliability is critical.

Why should patients care? Because many of the assessment tools available to clinicians - and widely utilized with patients - have poor inter-rater reliability. Take, for example, palpation - poor inter-rater reliability, yet the patient- and clinician-perceived "standard" for assessment. Movement- and provocation-based assessment tools provide far more consistent and valuable data and should be the standard for the assessment and diagnostic classification process.

2. Diagnosis - Treatment: The selection of a treatment intervention should be based upon a diagnostic classification. However, keep in mind that if the classification is inconsistent or built on poor reliability, then the selection of treatment intervention becomes far more arbitrary. Oh, and "diagnoses" like "back pain" don't count. Welcome to the king of arbitrary-ness.

Why should patients care? If you have been able to reliably establish a diagnostic classification, then there should be a natural progression to the selection of an appropriate treatment intervention. This consistency will, over the long term, foster consistency and reproducibility of care.

3. Treatment - Outcome: Once a treatment intervention is selected, it should be able to consistently provide a treatment effect - and subsequently a patient outcome in the vast majority of cases. This should not be arbitrary and, again, should be reproducible and consistent across the spectrum of patients yet with subtle variations in response due to age, immune status, and other related factors.

Why should patients care? Patients ultimately seek the best care for the condition or presenting problem. Unfortunately, over time there has been a gradual degradation of "accepted standard of care" such that patients have been taught to accept just about anything - arbitrary, scientifically plausible, or otherwise. Patients should be able to get the "best bang for their health care buck" which should consist of a standard of care based on reproducible treatment effects - and outcome - based on assessment and diagnosis.

4. The cumulative long-term benefits are substantial: A scientific-method-based model utilizing ADTO across the health care continuum will have very positive effects. It will make clinicians far more accountable. It will provide a sound foundation for researchers in their attempts to define efficacy and best practices. And, most importantly, it will provide patients with consistent and reproducible care that will ultimately be cost-effective in the process.

This is not only what health care needs, but what the health care consumer deserves.

Photo credits: abesselink

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