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Could Goldman’s Algorithm Play a Positive Role in Healthcare?

Submitted by on April 11, 2013 – 10:16 PM

MedicalConsidering how the leading NHS hospitals are at a breaking point just shows how health care is being adversely affected by the financial crunch, not to mention the non-existing attention to healthcare being given in developing countries. I recently came across the Goldman’s Algorithm in Malcolm Gladwell’s book ‘Blink’. And it occurred to me that if that is used properly it’s a step towards the right direction towards better healthcare and better economy.

Goldman’s Algorithm is fundamentally a decision tree. On a larger scale, it is an optimization model that reduces healthcare expense by filtering patients with the greatest need to the Coronary Care Unit. It frees up space and increases efficiency and significantly lowers the cost. In many researches, the Goldman Algorithm has actually increased the accuracy rate up to 93% from the usual 75-89%.

Since the chest pain patients have a specific set of protocols to get diagnosed, it is resource intensive. The treatment protocol is long and elaborate and worst of all maddeningly inconclusive. ECG is far from perfect and the only way to be sure is to involve tests regarding cardiac enzymes.

Take, for instance, a hypothetical case of a 60 year old man who comes into the ER complaining of intermittent left-side chest pain that occasionally comes and that lasts from 5 minutes to 3 hours and is sweating. His chest exam, heart exam, and ECG are normal, and his systolic blood pressure is 160, meaning it doesn’t qualify as an urgent factor. He’s an executive and is under constant stress. He smokes and does not exercise and is overweight. Moreover, he has hypertension and had heart surgery two years ago.

Instinctively, he should be admitted right away. But the algorithm says he shouldn’t be. These factors do matter in the long term. In fact, it may offer a subtle role in the next 72 hours.

What does Goldman’s Algorithm indicate? It tells us that these factors are not really important in telling us what is actually is happening to the patients right now. This is an important point. He would be sent home correctly and instead a needy patient’s life can be saved. Thus efficiency and economy – both are manageable. In fact, the Goldman’s algorithm is being modified by people in Neurological practice and being considered to be used for the patients suffering from depression.

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