Information Overload: PUTS to the Rescue

Many of us- health professionals or not- hear or read about medical research. TV, radio, papers, magazines and internet are some of the sources of medical information. Numerous sources of information competing for our attention have lead to the problems of mal-information and information overload. Mal-information can be due to some vested interests monopolizing our attention. Information overload has the potential of leaving us confused about some important basic concepts.

Some research that we read or hear about may impact the way healthcare is delivered, and some may have no significant impact. New kid on the block- blogosphere- has given several of us a unique opportunity to write on research and other topics. This helps readers get views from different angles. This however, also contributes to information overload.

Whenever a new research is presented, people wonder if they should rush to talk to their doctor about that ‘groundbreaking’ research. I think those who write or talk about the health research can help the public by providing a ranking to the research they write or talk about. Let us call it Pro-Per™ utility test score (PUTS). The scoring is on a scale of one to five. Higher the score, more the scorer thinks that the research topic will impact the way health care is provided.

Pro-Per™ Utility Test Score (PUTS)
0 PUTS. The research will not change the way health care is provided.
1 PUTS. The research will not make significant impact on healthcare delivery. Or it may say something that is already well known.
2 to 4 PUTS. The research may change the practice of medicine significantly. How significantly? It depends on what the scorer thinks. Same research may get different score from different scorers.
5 PUTS. The research will revolutionize practice of medicine.

Examples:
- High C-reactive protein (CRP) is thought to be associated with higher chance of heart problem. No study has shown that a measure that will cause pure CRP decrease (apart from treatment of already known risk factors) will translate into decreased chance of heart disease. So most CRP research will get a score of 0 to 1.
- A study suggested that non-specific EKG changes in women may mean higher chance of heart disease later. The physicians already routinely compare patients’ new EKGs with old EKGs for any fresh changes. Moreover, any additional steps in patients with non-specific EKG changes are unlikely to have significant impact on patient wellbeing. So this research will also get a score of 0 to 1.
- A study showed that a new antibiotic- Ketek- should not be used for simple bronchitis because of potential of serious side effects. Another study showed that frequent hand-washing will decrease the chance of infections. These two are likely to get a score of 2 to 4.
- Research showed that H. pylori- a bug- and not excessive acid is responsible for stomach ulcers. The discovery of a vaccine had the potential to eradicate a horrible disease like small pox. These two will likely get a score of 5.

According to PUTS system, most of the basic research will get zero Pro-Per™ utility test score (PUTS). This does not in any way diminish the importance of basic research. Moreover, a research that gets zero PUTS today may form the basis for a research with 5 PUTS in the future. PUTS will however, give us a good idea about the present utility of a research.
Pro-Per™ utility test score (PUTS) will help us provide the benefit of our expertise to the laity. By ‘laity’, I do not just mean patients. A cardiologist could be ‘laity’ for a topic on bone tumors or health care business, for example.
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What Is The Reason Behind Pay-For-Performance (P4P) System?

The American Medical Association (AMA) president William G. Plested III, MD wrote an article published in AMA news titled- Pay-for-performance: It's about cost control, not quality.

Pay-for-performance or P4P is a system with a premise that hospitals and physicians will be incentivized for better performance. The article by AMA president got me thinking about the reason behind pay-for-performance (P4P) concept.

Is it to assure quality? If this is to assure quality, what are the parameters of quality? I understand that tens of quality criteria are being measured for the calculation of incentives as a part of P4P.
A customer subconsciously uses tens of quality criteria before choosing a store that he or she buys groceries from. These criteria include: location of the store, parking, attitude of the employees, prices, placement of the goods- and the list goes on. The health care quality will need to be measured based on hundreds of quality criteria- some measurable (death rate, stroke rate etc.) and some not so easily measurable (emotional well-being, physician’s respect for patient’s belief system, etc.). Will we be able to measure all the important criteria for the purpose of P4P? If not, will we run the risk of ignoring the quality criteria that we are not being graded on- to the detriment of patient care?

Is it to cut cost? A common argument against ‘universal health care’ is that it will kill the type of care that American health system provides. This suggests people's satisfaction with quality of care. Moreover, commonest complaint against health care system at this time is the cost. Because of these issues, people wonder if pay-for-performance is a cost-cutting measure in the garb of a quality-enhancing measure. Is it? While it is easy to support attempts to get best value for every healthcare dollar spent, it is hard to imagine that P4P will be an effective cost-cutting measure.
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