Prerequisites for Stratification The event being predicted should be an important health problem. There should be an intervention that can mitigate the risk of the event; resources and systems for timely risk stratification and preventive interventions; sufficient time for intervention between stratification and the occurrence of the event; a sufficiently accurate predictive risk model for the event, which—together with the impact ability model—is acceptable to the population at large; and an accepted policy about who should be offered the preventive intervention.
In addition, the natural history—that is, the practices and processes that typically lead to this type of Triple Fail event—should be adequately understood by the organization offering the preventive intervention. The cost of stratification should be “economically balanced,” meaning that it should not be excessive relative to the cost of the program as a whole. And stratification should be a continuous process, not just a “once and for all” occurrence.
Access For Certain High-Risk Populations Another important ethical concern relates to the use of the impact ability modeling. Although certain subpopulations are at high risk, they may be denied preventive care because they are not expected to respond to it. For instance, people with personality disorders or alcohol dependency might not be amenable to programs aimed at preventing hospital readmission. The question is whether such people should be denied preventive care on this basis, which corresponds to Wilson and Jungner’s requirement that there be an accepted policy about who should be offered the intervention.
Nancy Kass argued that for reasons of distributive justice, programs should not exclude individuals on the basis of nonclinical characteristics such as race and sex. However, Andrew Smart, Paul Martin, and Michael Parker argued that such discrimination may be justified on the principle that it is permissible to treat people differently if there is some ethical justification. For example, programs that target low-income or uninsured people because of social justice considerations rightly treat different people differently.
Prerequisites for Stratification The event being predicted should be an important health problem. There should be an intervention that can mitigate the risk of the event; resources and systems for timely risk stratification and preventive interventions; sufficient time for intervention between stratification and the occurrence of the event; a sufficiently accurate predictive risk model for the event, which—together with the impact ability model—is acceptable to the population at large; and an accepted policy about who should be offered the preventive intervention.
In addition, the natural history—that is, the practices and processes that typically lead to this type of Triple Fail event—should be adequately understood by the organization offering the preventive intervention. The cost of stratification should be “economically balanced,” meaning that it should not be excessive relative to the cost of the program as a whole. And stratification should be a continuous process, not just a “once and for all” occurrence.
Access For Certain High-Risk Populations Another important ethical concern relates to the use of the impact ability modeling. Although certain subpopulations are at high risk, they may be denied preventive care because they are not expected to respond to it. For instance, people with personality disorders or alcohol dependency might not be amenable to programs aimed at preventing hospital readmission. The question is whether such people should be denied preventive care on this basis, which corresponds to Wilson and Jungner’s requirement that there be an accepted policy about who should be offered the intervention.
Nancy Kass argued that for reasons of distributive justice, programs should not exclude individuals on the basis of nonclinical characteristics such as race and sex. However, Andrew Smart, Paul Martin, and Michael Parker argued that such discrimination may be justified on the principle that it is permissible to treat people differently if there is some ethical justification. For example, programs that target low-income or uninsured people because of social justice considerations rightly treat different people differently.
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