55 Fruit St # 148
Boston, MA 02114
Institutional Affiliation: Harvard Medical School and Massachusetts General Hospital
NBER Working Papers and Publications
|July 2020||Mastering the Art of Cookbook Medicine: Machine Learning, Randomized Trials, and Misallocation|
with , , , : w27467
The application of machine learning (ML) to randomized controlled trials (RCTs) can quantify and improve misallocation in healthcare. We study the decision to prescribe anticoagulants for atrial fibrillation patients; anticoagulation reduces stroke risk but increases hemorrhage risk. We combine observational data on treatment choice and guideline use with ML estimates of heterogeneous treatment effects from eight RCTs. When physicians adopt a clinical guideline, treatment decisions shift towards the recommendation but adherence remains far from perfect. Improving guideline adherence would produce larger gains than informing physicians about guidelines. Adherence to an optimal rule would prevent 47% more strokes without increasing hemorrhages.