Slide 23. Prioritizing Risk Factors

Presentation describes the methods used by the US Preventive Services Task Force to develop recommendations.

Prioritizing Risk Factors

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  • How important is the target condition?
    • Incidence and prevalence.
    • Morbidity and mortality.
  • How important is the risk factor?
    • Frequency and magnitude (absolute risk, relative risk, attributable risk).
  • Is the preventive service efficacious and effective?
    • Ideal conditions vs. routine clinic setting.
  • How accurately can the risk factor or target condition be identified?
    • Must have a significant effect on the quality and quantity of life.
    • Sensitivity vs. specificity.

Notes:

PPIP pg xvii - xxv

These are questions to consider when prioritizing an assessment of risk factors that can increase a patient's potential for future disease and can be applied to all clinical preventive services.

How important is the target condition?

The target condition is the health or disease outcome that the preventive care intervention avoids (primary prevention). The frequency and severity of the target condition helps define its importance. The frequency is typically measured by its incidence rate and prevalence rate.
The severity of a target condition can be described by several measures: mortality, morbidity and survival rates. High frequency and greater severity, may merit greater preventive attention.

  • How important is the risk factor? frequency and magnitude (absolute risk, relative risk, attributable risk) Risk factors are the attributes associated with the target condition (i.e. demographic variables). A risk assessment is obtained through patient histories, targeted exams and lab tests. The magnitude of risk helps to quantify the association between the risk factor and the target condition. There are important differences between risk measures and disease prevention.
    • absolute risk: the incidence of the target condition in the population with the risk factor.
    • relative risk: the ration of the incidence of disease among persons with the risk factor to the incidence of disease among those without the risk factor.
    • attributable risk: the amount of risk that can be attributed to one particular risk factor (calculated by subtracting the incidence rate of the population without the factor from the incidence rate among the population with the factor).
  • Is the preventive service efficacious and effective? is it efficacious (ideal conditions [research environment] vs. routine clinic setting).
    • Must have a significant effect on the quality and quantity of life.
    • USPSTF has developed a rating system of quality of scientific evidence.
  • How accurately a risk factor or target condition be identified?
    • Sensitivity refers to the proportion of persons with a condition who correctly test positive when screened.
    • Specificity refers to the proportion of persons without the condition who correctly test negative when screened.
    • Positive predictive value (PPV) is the proportion of positive test results that are correct (true positives).

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Current as of October 2011
Internet Citation: Slide 23. Prioritizing Risk Factors. October 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/ppip/ppipslides/ppiplongsl23.html