Clinical Decision Ambiguity and Conflicts of Interest in Interventional Cardiology Decision-Making
Tinglong Dai, PhD Assistant Professor; Johns Hopkins University, Carey Business School, Baltimore, MD, USA
Abstract
Cardiovascular
disease
is
the
leading
cause
of
death
in
the
United
States,
and
coronary
artery
disease
(CAD)
is
the
major
underlying
culprit.
Percutaneous
coronary
intervention
(PCI)
has
proven
to
be
beneficial
to
patients
with
acute
coronary
syndrome,
but
its
benefit
to
stable
CAD
patients
is
more
nuanced.
Indeed,
unnecessary
PCIs
for
stable
CAD
patients
have
contributed
to
wasteful
health
spending
and,
in
certain
cases,
to
patient
harm.
In
this
paper,
we
seek
to
understand
the
decision-making
of
PCIs
by
modeling
both
clinical
considerations
(i.e.,
clinical
decision
ambiguity)
and
non-clinical
motives
(i.e.,
conflicts
of
interest)
in
a
physician’s
mental
accounting
process.
The
decision-making
of
PCIs
can
be
solely
based
on
the
physician’s
reading
of
a
coronary
angiogram,
or
in
conjunction
with
an
advanced
test
such
as
fractional
flow
reserve
(FFR).
In
the
case
of
angiogram-guided
decision-making,
we
find
that
the
existence
of
conflicts
of
interest
drives
more
inappropriate
PCI
procedures.
In
addition,
clinical
decision
ambiguity
amplifies
such
an
effect.
In
the
case
with
the
option
of
an
advanced
test,
we
characterize
the
physician’s
decision
rule
in
ordering
the
advanced
test:
under
a
low
level
of
conflicts
of
interest,
the
physician
orders
the
advanced
test
when
decision
ambiguity
is
sufficiently
high;
under
a
high
level
of
conflicts
of
interest,
however,
the
physician
may
find
it
optimal
to
order
the
advanced
test
when
the
decision
ambiguity
is
sufficiently
low.
Our
results
also
allude
to
a
technological
approach
to
addressing
the
ethical
conundrum
emerging
out
of
the
interaction
between
clinical
decision
ambiguity
and
conflicts
of
interest.
This
is
a
joint
work
with
Chao-Wei
Hwang,
MD
(Johns
Hopkins
Hospital)
and
Xiaofang
Wang
(Renmin
Business
School).
Biographical Sketch
Tinglong Dai is an Assistant Professor of Operations Management at the Johns Hopkins University, Carey Business School. He received a PhD in Operations Management/Robotics (2013), jointly offered by Tepper School of Business and the Robotics Institute of Carnegie Mellon University, with a dissertation entitled “Incentives in U.S. Healthcare Operations.” He also received an MS in Industrial Administration from Carnegie Mellon in 2009, an MPhil in Industrial Engineering and Engineering Management from the Hong Kong University of Science and Technology in 2006, and a BEng in Automation from Tongji University in 2004.
Dr. Dai is the recipient of the 2012 POMS Best Paper in Healthcare Award, the 2012 INFORMS Pierskalla Runner Up Award for the Best Paper in Healthcare, and 2nd Place Award in the 2012 INFORMS Case and Teaching Materials Competition. He is a finalist in the 2014 Elwood S. Buffa Doctoral Dissertation Award, and the 2013 POMS College of Supply Chain Management Best Student Paper Competition. His research has been published in leading journals such as Management Science. He has been cited in MedPageToday.com, Baltimore Sun, and Maryland Daily Record. His research areas include incentives in healthcare operations, marketing-operations interfaces, and group decision and negotiation.
*Light refreshments will be served at 12:00pm