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[PAST EVENT] Mathematics Colloquium and EXTREEMS-QED Lecture: Tinglong Dai (Johns Hopkins University)
April 29, 2016
2pm - 3pm
Abstract:
Cardiovascular disease is the leading cause of death in the United States, and coronary artery disease (CAD) is the major underlying culprit. Percutaneous coronary intervention (PCI) has proven to be beneficial to patients with acute coronary syndrome, yet its benefit to stable CAD patients is more nuanced. Indeed, unnecessary PCI procedures for stable CAD patients have contributed to wasteful health spending and, in certain cases, patient harm. In this paper, we model both clinical ambiguity and conflicts of interest in interventional cardiology decision-making. The decision-making can be based solely on the physician?s reading of a coronary angiogram, or in conjunction with an optional advanced intracoronary test (e.g., fractional flow reserve) that provides a more objective basis for clinical decisions but introduces additional patient risk. We find that under a low conflict-of-interest level, the physician chooses to perform the advanced test primarily to mitigate clinical ambiguity; under a high conflict-of-interest level, however, the physician may perform the advanced test even when little or no clinical ambiguity exists. By incorporating the option to perform the advanced test, our results show the PCI usage may be non-monotonic in the conflict-of- interest level, indicating that directly influencing the conflict-of-interest level may backfire and lead to more PCI usage. By contrast, increasing the reimbursement rate for the advanced test and reducing its risk can effectively decrease PCI usage even under a high conflict-of-interest level, alluding to an operational approach to addressing the ethical conundrum.
Cardiovascular disease is the leading cause of death in the United States, and coronary artery disease (CAD) is the major underlying culprit. Percutaneous coronary intervention (PCI) has proven to be beneficial to patients with acute coronary syndrome, yet its benefit to stable CAD patients is more nuanced. Indeed, unnecessary PCI procedures for stable CAD patients have contributed to wasteful health spending and, in certain cases, patient harm. In this paper, we model both clinical ambiguity and conflicts of interest in interventional cardiology decision-making. The decision-making can be based solely on the physician?s reading of a coronary angiogram, or in conjunction with an optional advanced intracoronary test (e.g., fractional flow reserve) that provides a more objective basis for clinical decisions but introduces additional patient risk. We find that under a low conflict-of-interest level, the physician chooses to perform the advanced test primarily to mitigate clinical ambiguity; under a high conflict-of-interest level, however, the physician may perform the advanced test even when little or no clinical ambiguity exists. By incorporating the option to perform the advanced test, our results show the PCI usage may be non-monotonic in the conflict-of- interest level, indicating that directly influencing the conflict-of-interest level may backfire and lead to more PCI usage. By contrast, increasing the reimbursement rate for the advanced test and reducing its risk can effectively decrease PCI usage even under a high conflict-of-interest level, alluding to an operational approach to addressing the ethical conundrum.
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Anh Ninh