Behavioral Economics of Clinical Decision Making
TIRDH 2015
Kaiser Permanente, Pasadena CA
History of Behavioral Economics
•
•
Originated with analysis of effective tactics in sales, social psychology, and
psychophysics
User Experience, Pricing Strategy, Warranty Offerings, capitalize on
violations of “Homo Economicus” assumptions:
–
–
–
–
•
Loss Aversion & Risk Aversion
Enlistment
Social Norms
Availability & Recency Bias
Not necessarily new science, but a framework that captures interdisciplinary
findings into a common (and occasionally quantitative) theoretical
framework.
Clinical Behavioral Economics is an Interdisciplinary
Science
Clinicians
• Defining (and creating) Problems
• Clinical analysis
• Developing solution specifications
Psychologists
• Theoretical analysis
• Developing solution specifications
Informaticists
• Technical analysis
• Developing solution specifications
• Implementation and measurement
Public Commitment
Clinician Public Commitment
60%
50%
40%
30%
20%
10%
0%
5
6
Decision Fatigue: Erosion of Decision Quality
Judicial Decisions Revert to Path of Least Resistance
lunch
Clinician Decisions
Inappropriate Prescribing by Shift Time
O.R. 1.26
User Experience: Design Effects in Wine Selection
User Experience: Design Effects in Clinical Decisions
Vignettes: Infection Scenarios
Visual Grouping
Version 1: Encourages Selecting non-aggressive Tx
Version 2: Encourages Selecting Aggressive Tx
Results: Interface Design is Effective in Hypothetical Scenarios
(N=84 Clinicians)
Peer Comparisons & Professional Accountability
Intervention 1: Traditional Best Practice Alerts
EHR System: LMR
Intervention 2: Peer & Professional Accountability
Patient has asthma.
EHR System: Epic
Intervention 3: Peer Comparison Emails
“You are a Top Performer”
You are in the top 10% of clinicians. You wrote 0
prescriptions out of 21 acute respiratory infection cases
that did not warrant antibiotics.
“You are not a Top Performer”
Your inappropriate antibiotic prescribing rate is 15%. Top
performers' rate is 0%. You wrote 3 prescriptions out of
20 acute respiratory infection cases that did not warrant
antibiotics.
Unadjusted Rates of Prescribing
Adjusted Results: Inappropriate Prescribing
Summary: Clinicians too, are Human
Applications of Behavioral Economic Theory:
• Can improve decision-making with social factors
• Can improve (or impair) decision-making with human
factors of interface design
• Fatigue impairs decision-making