Decision fatigue in low-value prostate cancer screening

Increasing the value of PSA through improved implementation

Low-value testing and treatment contribute to billions of dollars in waste to the United States health care system annually. High frequency, low-cost testing, including prostate-specific antigen (PSA) testing, is a major contributor to this inefficient health care delivery. Despite decreasing mortality of prostate cancer over the last few decades, the reputation of prostate specific antigen (PSA) for prostate cancer screening has fluctuated over the last decade due to lack of clarity of the benefits of screening and high risk for overtreatment. The value of PSA could be improved by efficient implementation of smarter testing strategies that reduce the harms and increase the benefits.

Do breaks from surgery improve the performance of orthopaedic surgeons?

This paper explores whether breaks from surgical practice impact surgeons' performance. Using a large panel of orthopaedic surgeons in England, I estimate the effect of surgeons' breaks, measured by the number of days since their last surgery, on the health outcomes of emergency patients admitted after a hip fracture. To identify a causal effect, I implement a surgeon fixed effects model and exploit the quasi-exogenous variation in breaks from unanticipated emergency hip fracture admissions. Results show that short breaks of four to six days reduce 30-day mortality rates by around six percent relative to no breaks. Notably, short breaks also affect the type of surgery carried out, holding patient characteristics fixed. Overall, these findings show that the organisation of surgeons' activity is a possible determinant of the quality of care provided.