When health care reform became a hot topic in the 2012 U.S. presidential election, Pranav Puri’s interest in politics led him to examine a major development at his hometown hospital. In February 2012, UnityPoint Trinity Hospital in Rock Island, Ill., became one of the first in the country to implement the American College of Cardiology’s appropriate use criteria, or AUC, for coronary revascularization.
The criteria take into account “the results of stress testing, the number and location of blockages, the patient’s symptoms, medications and different metrics,” said Puri, a first-year at the University of Chicago, and then “score a prospective procedure into appropriate, inappropriate or uncertain.” His research then sought to understand the long-term economic impacts of the regime shift.
In observing the volume of interventions, he found a 17 percent decrease from 2011 to 2012, the first year of implementation, and a further 17 percent drop from 2012 to 2013. The sustained decrease in interventions over two years suggests that nationwide implementation of AUC could see a cost savings of more than $2.3 billion.
Given the potential significance of his findings, Puri was selected to present his research at the American College of Cardiology Annual Scientific Session in San Diego, which was attended by more than 15,000 cardiologists. “As a first-year amongst well-tenured cardiologists and researchers, this was a very exciting and unique experience for me,” he said.
Puri warns people not to see his research as a reason to question the current practices of physicians. “I think maybe the easy takeaway just at first glance is that, ‘Wow, everybody’s doing way too many interventions,’ but it’s a little bit more nuanced than that,” said Puri. Each case is different, and the AUC are not meant to undermine the complexity of the clinical decision-making process. They simply add another line of evidence.
There is also a data trend that shows a troubling decrease in appropriate interventions from year one to year two of implementation. Puri’s study doesn’t look at patient outcomes, but it raises questions. If the appropriate interventions are declining, is there a certain population that isn’t getting appropriate care? He hopes to look into the problem this summer and help pinpoint the true impact of AUC implementation.
Above all, the research show that, “As physicians are more informed when making decisions, costs come down,” Puri said.
Puri’s two co-authors, Bobette Patterson and Jennifer Carroll, are both registered nurses at UnityPoint Trinity Hospital that aided in the hospital oversight of the project. They noted in a joint email that, for health care professionals, “this brings awareness to others regarding cost of care and payment card industry procedures. How following specific, evidence-based protocols for decision-making will decrease cost to the health care payers, while still providing ideal care.”
As for the future, Puri plans to complete his pre-med requirements. Although undecided about his major, his interests lie at the intersection of economics and health care. His co-authors believe that Puri has the characteristics to make an impact in whichever field he chooses: “Pranav is very mature in his ability to initiate this type of work. We feel he is an excellent leader and will do great things in the future.”
—Prof. Kunle Odunsi
