Examining the role of single versus dual decision-making approach for patient care: Evidence from cardiology patients

Abstract

Research in healthcare suggests that repeated interaction between a provider and a patient can support better decision-making, resulting in improved efficiencies. To date, these repeated interactions enabling continuity of care have not been studied in hospital inpatient settings. During a hospital stay, decisions related to patient treatment are usually made 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; in contrast, under the dual decision-making approach (D-DMA), the AP and OP are different. In recent years, there has been an increasing trend toward the use of D-DMA over S-DMA across U.S. hospitals owing to scheduling conflicts. Although research outside healthcare operations management has argued for benefits from both approaches, their impacts on a patient's hospital stay are unclear. In this study, we address this gap by investigating the effects of S-DMA and D-DMA on patient care outcomes in terms of patient length of stay (LOS), treatment cost, and mortality. Data for our study come from the state of Florida and involve 520,554 cardiology patients treated by 9483 APs and 18,398 OPs at 241 hospitals between 2014 and 2016. We account for both patient and physician selection issues when choosing a particular decision-making strategy. Our results suggest that, on average, using S-DMA is associated with reduced patient LOS and treatment cost but has no effect on mortality. We also find that S-DMA is more beneficial for patients with low comorbidity and low process uncertainty, whereas D-DMA is more beneficial for patients with high comorbidity and high process uncertainty. Our results are robust to alternative explanations. We demonstrate that a single decision-maker offers benefits in the context of healthcare delivery, but dual decision-makers may yield benefits when caring for patients with high comorbidity and high process complexity. We discuss the implications of these findings for appropriately deploying S-DMA and D-DMA in inpatient services.