# Risk Aversion, Fear of Malpractice, and Medical Decision Making in the Emergency Department

> **NIH AHRQ R01** · HARVARD MEDICAL SCHOOL · 2021 · $390,338

## Abstract

Project Summary:
Individual physician decision-making is an important determinant of the extent of variation in health care
practice in the U.S. The emergency department (ED) presents an ideal setting for studying the determinants of
variation in decision-making. Knowing the fundamental importance of risk aversion in lay decision-making, we
hypothesize that risk aversion has the potential for an even stronger influence on emergency physicians (EPs)
because of the high stakes and uncertain nature of emergency care.
This study will focus on risk aversion and Need for Cognitive Closure (NFC), related traits that might have a
profound impact on decision-making in the ED. Together, these traits translate into a certain level of clinical
anxiety or compulsiveness amongst EPs. The distribution of this trait amongst EPs is unclear, as is whether
this personality trait is beneficial or harmful for patients. It is likely that a particularly anxious or compulsive EP
will be vulnerable to over-testing (errors of commission), and that this over-testing results in potentially harmful
downstream outcomes. Yet, in the ED setting it is possible that for some clinical conditions, over-testing in the
ED setting might be protective by minimizing missed diagnoses and picking up on potentially critical diagnoses.
It simply is unknown and critical to define for most ED conditions whether higher or lower testing is better, or if
a range of testing is associated with better outcomes. A critical need exists to determine whether these traits
are associated with the intensity of workups and admission decisions in the ED. Delineating this relationship is
essential to devising interventions to educate EPs about their intrinsic risk aversion or to set expectations of an
ideal level of practice intensity for key clinical conditions. Yet, even the prevalence of risk aversion and NFC
amongst EPs – and the relationship between them and decision-making – is largely unknown.
The proposed study will combine survey data from EPs – as well as from Advanced Practice Providers given
their increasing role in the provision of emergency care- across Massachusetts with utilization data from an all
payer claims database (which we will construct by combining Medicare claims data and the Massachusetts All
Payer Claims Database) to accomplish three key aims. First we will measure the prevalence and distribution of
risk aversion and NFC in the population of Massachusetts EPs/APPs. We will then determine the relationship
between provider risk aversion/NFC scores and practice intensity (the number of laboratory tests, imaging
studies, and the frequency of hospital admission) for key clinical conditions in the ED. Finally, we will examine
the relationship between practice intensity and patient harm, leveraging the fact that patients are randomly
assigned to EPs. In addition to shedding light on a largely unexplored area of medical decision-making, our
findings will serve as the foundation for the de...

## Key facts

- **NIH application ID:** 10242666
- **Project number:** 5R01HS026730-03
- **Recipient organization:** HARVARD MEDICAL SCHOOL
- **Principal Investigator:** Bruce E. Landon
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $390,338
- **Award type:** 5
- **Project period:** 2019-09-01 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10242666

## Citation

> US National Institutes of Health, RePORTER application 10242666, Risk Aversion, Fear of Malpractice, and Medical Decision Making in the Emergency Department (5R01HS026730-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10242666. Licensed CC0.

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