Examining the Role of Single Versus Dual Decision-Making Approach for Patient Care: Evidence From Hospital Inpatient Settings

Decisions related to patient treatment during a given hospital stay are usually done by two key decision-makers: The attending physician (AP) and the operating physician (OP). Under the single decision-making approach (S-DMA), the AP and OP are the same, whereas, under the dual decision-making approach (D-DMA), the AP and OP are different. In recent years, there has been an increasing trend towards using D-DMA over S-DMA across US hospitals to accommodate physician schedules and to incorporate diverse viewpoints. While research outside healthcare operations management has argued for benefits from both S-DMA and D-DMA approaches, very little knowledge exists on what is effective during the delivery of care for a given episode. In this study, we address this gap by investigating the patient care outcomes in terms of patient length-of-stay, treatment cost and mortality when using S-DMA and D-DMA approaches to medical decision-making. Data for our study comes from the state of Florida and involves 520,554 cardiology patients treated by 9,483 attending physicians and 18,398 operating physicians at 241 hospitals from 2014 to 2016. We account for both the patient and physician selection issues for choosing a particular decision-making strategy. Results from our analyses suggest that the use of S-DMA is associated with reduced patient length of stay and lower treatment cost but has no effect on mortality. This runs counter to some of the trends observed in practice. Follow-up conversations with physicians and hospital leaders suggest that the decisions to incorporate D-DMA over S-DMA are mostly to accommodate schedules and our results offer important insight on the quality and cost of care from these decisions. We also find that the effect of S-DMA is more beneficial for patients with greater disease complexity. A follow-up post-hoc analyses also reveals that S-DMA is more critical than physician specialization. Our results are robust to alternate explanations and demonstrate the role that physicians can play in effective care treatment during a hospital stay.

This seminar will take place in T10-67. To join online, find the details below:
https://eur-nl.zoom.us/j/96691353688

Meeting ID: 966 9135 3688