The Role of Informational Environments in Physician Decision-Making Open Access

Abstract

Physicians wield considerable influence over their patients’ lives. They are entrusted with making serious, life-changing decisions that the patient is incapable of (or unqualified to be) making. As such, it is important that they base these decisions on diagnostic factors, such as patient symptomology and disease etiology, to provide care that is both efficient and equitable. However, a wealth of literature has shown that physician decisions are affected by non-diagnostic information cues that stem from the environments they work within. This dissertation aims to study how physicians rely on non-diagnostic information to provide care, and how it affects patients’ health outcomes. My first chapter looks at the effects of individual-level factors, namely, physicians’ adverse experiences with prior patients, on physician decision-making. My second and third chapters look at the effects of organizational factors, namely, hospital ICU capacity, on physician decisions.

 

The findings of this dissertation provide evidence that physician decisions are often affected by informational cues independent of the patients’ clinical indication, which can lead to suboptimal care. These results have implications for physician training and decision choice architecture. Policies and health systems can be designed to nudge physicians into ignoring idiosyncratic, extraneous information and making better clinical decisions, thereby improving the health of the populations they serve.

Table of Contents

Chapter 1: What Passed is Past? The Role of Recent Adverse Event in Physician Treatment Decisions 1

Introduction 1

Methods 6

Results 10

Mechanisms 23

Conclusion 31

Appendices 43

References 51

 

Chapter 2: ICU Beds and ICU Admission: An Instrumental Variables Analysis 55

Introduction 55

Methods 56

Results 60

Discussion 64

Conclusion 65

Appendices 74

References 82

 

Chapter 3: Strained and Constrained: How Capacity Affects Physician Decisions in the ICU 85

Introduction 85

Institutional Background 89

Data 96

Empirical Strategy 98

Results 101

Conclusion 104

References 118

About this Dissertation

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School	Laney Graduate School
Department	Health Services and Research Health Policy
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Health Sciences, Health Care Management Economics, General
Keyword	Physician Behavior Decision-Making Under Uncertainty Learning
Committee Chair / Thesis Advisor	Howard, David, Emory University
Committee Members	Druss, Benjamin , Emory University Valley, Thomas, University of Michigan McCarthy, Ian, Emory University

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