The Development of a Risk Assessment Model for the Health Service. Dr. Chakib Kara-Zaitri, Deputy Director, Disaster Prevention and Limitation Unit, Lecturer in Risk and Reliability, University of Bradford, Bradford BD7 1DP, telephone +44 1274 384253, fax +44 1274 391 333, e-mail c.karazaitri@bradford.ac.uk; and Dr. Ruth Gelletlie, Consultant in Communicable Disease Control, Bradford Health Authority, New Mill, Victoria Road, Saltaire, Shipley BD 18 3LD, telephone +44 1274 366007, fax +44 1274 366060
The paper deals with the development of an efficient risk assessment model to be used by Communicable Disease Control Consultants (CDCC) in the UK Health Service. CDCCs have the responsibility of making sound decisions distinguishing an isolated case of say Tuberculosis against an epidemic situation based on several factors. Much of this knowledge is based on long experiences of Experts who inherently use varying cognitive reasoning to reach a given decision - i.e. discard the case or close the entire school and inject every pupil with antibiotics. This knowledge and experience is extremely valuable but is, so far, stored in the Experts brains and is not effectively shared. This paper attempts to document the inherent reasoning process and identifies common factors and components of the decision making process. The paper develops a model designed to handle both qualitative and quantitative data. In particular, the model developed focuses on the computation of a quantitative Risk Priority Index - an idea borrowed from well-known risk and reliability assessment and modeling tools. The paper reviews relevant existing literature and critically examines important issues. The literature review is augmented by in-depth interviews with ten CDCCs in the UK. The objectives of the interviews are to draw individual and group cognitive maps of the CDCCs during the risk assessment process in a real situation, and to identify the critical factors of the decision-making process. The factors thus identified are used in a protocol of rules using the general modus ponens principle : IF (X is A) AND (Yis B) AND ….. then (Z is W). A new input is then tested against the protocol of rules to advise on the best action to take given the circumstances of the case. The factors include the "social grading" of the geographical location, the potential contamination, the severity of the symptoms and the effect of the media. The model developed is validated in real cases relating to Meningitis and Tuberculosis.
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