Working Paper: NBER ID: w23915
Authors: Charles F. Manski
Abstract: This paper discusses how limited ability to assess patient risk of illness and predict treatment response may affect the welfare achieved by adherence to clinical practice guidelines and by decentralized clinical practice. I explain why predictive ability has been limited, calling attention to imperfections in clinical judgment and to questionable methodological practices in the research that supports evidence-based medicine. I discuss recent econometric research that can improve the ability of guideline developers and clinicians to predict patient outcomes. Recognizing that uncertainty will continue to afflict medical decision making, I apply basic decision theory to suggest reasonable decision criteria with well-understood welfare properties.
Keywords: clinical practice guidelines; decision theory; patient outcomes; evidence-based medicine
JEL Codes: C4; D81; I10
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Adherence to clinical practice guidelines (CPGs) (I10) | Patient welfare outcomes (I11) |
| Decentralized decision-making by clinicians (D91) | Patient welfare outcomes (I11) |
| Adherence to clinical practice guidelines (CPGs) (I10) | Inferior welfare outcomes (D69) |
| Clinical judgment (D87) | Treatment decisions (D87) |
| Predictive ability of guideline developers (C52) | Patient welfare outcomes (I11) |
| Adherence to clinical practice guidelines (CPGs) (I10) | Unwarranted variation in clinical practice (I11) |