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
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).
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
200 University Avenue West
Waterloo, ON N2L 3G1