Working Paper: NBER ID: w27467
Authors: Jason Abaluck; Leila Agha; David C. Chan Jr.; Daniel Singer; Diana Zhu
Abstract: Expert decisions often deviate from evidence-based guidelines. If experts are unaware of guidelines, dissemination may improve outcomes. If experts are aware of guidelines but continue to deviate, promoting stricter adherence has ambiguous effects on outcomes depending on whether experts have information not in guidelines. We study guidelines for anticoagulant use to prevent strokes among atrial fibrillation patients. By text-mining physician notes, we identify when physicians start using guidelines. After mentioning guidelines, physicians become more guideline-concordant, but adherence remains far from perfect. To evaluate whether nonadherence reflects physicians’ superior information, we combine observational data on treatment choices with machine learning estimates of heterogeneous treatment effects from eight randomized trials. Most departures from guidelines are not justified by measurable treatment effect heterogeneity. Promoting stricter adherence to guidelines could prevent 24% more strokes, producing much larger gains than broader guideline awareness.
Keywords: guideline adherence; healthcare allocation; machine learning; anticoagulation; atrial fibrillation
JEL Codes: I11; I18; O33
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Increased awareness of the CHADS2 guideline (I10) | Significant shift in physician prescribing behavior (I11) |
| Stricter adherence to guidelines (I10) | Greater improvements in patient outcomes (I14) |
| Increased awareness of the CHADS2 guideline (I10) | Incorporation of guideline awareness into clinical decision-making (D91) |
| Stricter adherence to guidelines (I10) | Improvements in patient outcomes (I14) |