THE SOCIETY OF PROSPECTIVE MEDICINE

GUIDELINES FOR HEALTH RISK APPRAISAL/REDUCTION SYSTEMS

PURPOSE

The Society of Prospective Medicine is concerned with encouraging high standards in the application of programs of health risk appraisal and reduction. Accordingly it has set forth attributes which are considered essential to such programs.

The Guidelines are intended to assist not only individuals and organizations who are providing risk appraisal/reduction programs, but also individuals and organizations who are seeking to utilize such programs.

The Society does not intend to impose the Guidelines; rather it is hoped that they will be accepted voluntarily. The Society believes that their use will encourage providers to strive for excellence in the delivery of health risk.

The Guidelines will be presented in two parts, and will be updated periodically. The first part, immediately following, covers the minimum guidelines, or essentials; the second, now under development, will include those attributes considered strongly desirable.

DEFINITIONS

Health Risk Appraisal/Reduction is the art and science of identifying an individual's present and potential health hazards and of helping him/her reduce those risks so as to extend useful life expectancy, improve the quality of life, and reduce morbidity and disability.

Health Risk Appraisal evaluates an individual's lifestyle/health behaviors, estimates his/her risk of death and/or illness, and estimates potential reduction in risk based on epidemiological data, mortality statistics, and actuarial techniques. Feedback is given to the individual based on his/her current and achievable risks.

Risk Appraisal Instruments are printed or computer-assisted questionnaires used to identify an individual's health risk.

Risk Reduction Programs are organized activities to reduce risk through sustained behavior change. These programs can be of long or short duration and of a broad or categorical nature.

Providers are the individuals, institutions or organizations providing risk appraisal/reduction programs to individuals or groups of individuals.

Participants are the individuals whose health risks are being appraised and who may, if appropriate, participate in some components of a risk reduction program.

Essentials are the basic attributes that should be present in any program of risk appraisal/reduction. They remain the same for all programs, whether institutionally based or free-standing, whether limited to a one-month community cardiovascular risk program or as extensive as an industry-wide, ongoing health risk appraisal program.

ESSENTIALS

The following should be present in every program:

1. The Written Statement of the Objectives of the Program, and Limitations

The statement should include a concise, realistic definition of goals; the scope of the program (general health vs. Categorical efforts); duration (ongoing vs. Short term); target audience; affiliation or sponsorship; and limitations.

2. Evidence of a Scientific Base for the Risk Appraisal Instrument.

Evidence should include references to morality and/or morbidity data bases from which the risk appraisal instrument is constructed; to the methodology for quantifying the risk factors; and to any studies regarding the relevance and validity of the risk appraisal instrument. An effort should be made to incorporate current "state-of-the-art: data and methods.

3. Evidence that Appropriate Risk Reduction Resources are Available to Participants.

Risk reduction resources should have a scientific basis, to the extent possible, and should be culturally appropriate for the target participants. Resources should be made available consistent with the risk indicators appraised. For example, if lifestyle stress risks are included in the appraisal, resources should be available for stress reduction. The provider may offer its own programs or may identify community resources that serve the purpose. An effort should be made to incorporate current "state-of-the-art" data and methods.

4. Demonstration of Staff's Capability to Organize and Conduct Risk Appraisal/Reduction Programs in Accordance with Stated Objectives.

Each program should be able to meet its objectives in terms of budget, facilities, staff, and consultants. The latter should have the experience and/or training needed to promote the program, administer risk appraisal instruments in a valid manner, and interpret the results to participants so as to encourage optimal risk reduction activity. Providers should exemplify positive personal lifestyles coupled with professional commitment.

5. Evidence that Participants Receive the Results of Their Appraisals in a Form They Can Comprehend, Including Recommendations to Consult an Appropriate Health Provider When Needed.

Existence of an operating feedback loop is critical to the integrity and success of the program. The risk appraisal instrument must be understandable enough to get meaningful responses. The reporting of results and recommendations for risk reduction must be individualized, relevant and understandable. If a medical or other serious health problem is detected, the participant should be notified and encouraged to consult a physician or other health provider. Followup to monitor risk reduction compliance is also desirable.

6. Mechanisms to Protect the Confidentiality of the Data on Individual Participants.

Only the participant, and health professionals authorized by the participant, should receive a copy of, or otherwise have access to, his/her own risk appraisal or results of risk reduction activity. If there is any need to reveal participant's identities, written consent should also be obtained before releasing aggregate data.

7. Evidence of Efforts to Evaluate the Program Periodically In Relation To Objectives.

Evaluation is a judgment about the program and its effectiveness in identifying and reducing health risk. It assesses the extent to which the program objectives have been met, for example, to observe whether the program has had an effect on the lifestyle of the participants. Evaluation also implies a review of program objectives in light of research in the field. There should be a plan for periodic evaluation, communication of the results, and action based thereon.