Fixing Misallocation with Guidelines: Awareness vs. Adherence

Jason Abaluck, Leila Agha, David C. Chan, Daniel Singer and Diana Zhu

No 27467, NBER Working Papers from National Bureau of Economic Research, Inc

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.

JEL-codes: I11 I18 O33 (search for similar items in EconPapers)
Date: 2020-07
New Economics Papers: this item is included in nep-big, nep-cmp, nep-exp and nep-hea
Note: AG EH LS PE PR
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (6)

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