Current obstacles in replicating risk assessment findings: a systematic review of commonly used actuarial instruments.

An actuarial risk assessment instrument can be considered valid if independent investigations using novel samples can replicate the findings of the instrument's development study. In order for a study to qualify as a replication, it has to adhere to the methodological protocol of the development study with respect to key design characteristics, as well as ensuring that manual-recommended guidelines of test administration have been followed. A systematic search was conducted to identify predictive validity studies (N = 84) on three commonly used actuarial instruments: the Violence Risk Appraisal Guide (VRAG), the Sex Offender Risk Appraisal Guide (SORAG), and the Static-99. Sample (sex, age, criminal history) and design (follow-up, attrition, recidivism) characteristics, as well as markers of assessment integrity (scoring reliability, item omissions, prorating procedure), were extracted from 84 studies comprising 108 samples. None of the replications matched the development study of the instrument they were attempting to cross-validate with respect to key sample and design characteristics. Furthermore none of the replications strictly followed the manual-recommended guidelines for the instruments' administration. Additional replication studies that follow the methodological protocols outlined in actuarial instruments' development studies are needed before claims of generalizability can be made.

Patient Protection and Affordable Care Act; standards related to essential health benefits, actuarial value and accreditation. Final rule.

This final rule sets forth standards for health insurance issuers consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Specifically, this final rule outlines Exchange and issuer standards related to coverage of essential health benefits and actuarial value. This rule also finalizes a timeline for qualified health plans to be accredited in Federally-facilitated Exchanges and amends regulations providing an application process for the recognition of additional accrediting entities for purposes of certification of qualified health plans.

Risk, Risk Assessment, and Community Corrections in China.

Although risk in the criminal justice field has been subject to intensive international debate, it has not incorporated China and its growing field of community corrections. This article assesses the current initiative of developing actuarial assessment tools in China and contrasts this with its use in the correctional context. There is certainly a rift in the understanding of risk, particularly, between the risk factors in Western risk assessment tools, the political construction of risk, and the local practitioners' embrace of correctional work. However, this article suggests that under the current mode of risk governance in China, actuarial assessment tools promoted in the correctional field simply add another layer of social control. The article highlights the importance of political and social rationalities and environments behind the construction of risk.

Actuarial assessment of violence risk in hospital-based partner assault clinics.

Hospital-based partner assault clinics are a relatively recent addition to the community response to partner violence. In this study, 66% of 111 women attending hospital clinics for partner assault were physically injured and 43% reported death threats. Few concurrently used other services (shelters or police) and most relied on female friends and relatives for help. Many participants who currently lived with the perpetrator were contemplating leaving but only a third had made plans to do so. Participants faced an unusually high risk of future assault, according to both victim interview using the ODARA actuarial risk assessment and their own perceptions. Findings imply an important role for partner assault clinics and the feasibility of the victim service sector's using the same actuarial risk assessments as the criminal justice system.

Precision of actuarial risk assessment instruments: evaluating the 'margins of error' of group v. individual predictions of violence.

BACKGROUND: Actuarial risk assessment instruments (ARAIs) estimate the probability that individuals will engage in future violence. AIMS: To evaluate the ;margins of error' at the group and individual level for risk estimates made using ARAIs. METHOD: An established statistical method was used to construct 95% CI for group and individual risk estimates made using two popular ARAIs. RESULTS: The 95% CI were large for risk estimates at the group level; at the individual level, they were so high as to render risk estimates virtually meaningless. CONCLUSIONS: The ARAIs cannot be used to estimate an individual's risk for future violence with any reasonable degree of certainty and should be used with great caution or not at all. In theory, reasonably precise group estimates could be made using ARAIs if developers used very large construction samples and if the tests included few score categories with extreme risk estimates.

Monthly actuarial rates and monthly premium rate--Health and Human Services Department. General notice.

This notice announces the monthly actuarial rates for aged (age 65 or over) and disabled (under age 65) enrollees in the Medicare Supplementary Medical Insurance (SMI) program for the 12 months beginning July 1983. It also announces the monthly SMI premium rate to be paid by all enrollees during the 12 months beginning July 1983. The premium rate in this notice is calculated under the provisions of section 1839(c)(3) of the Social Security Act as modified by section 124 of the TAx Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248, which temporarily holds the SMI premium at a constant percentage of the monthly actuarial rate for aged beneficiaries.

Monthly actuarial rates and monthly premium rate. Office of the Secretary. General notice.

This notice announces the monthly actuarial rates for aged (age 65 or over) and disabled (under age 65) enrollees in the Medicare. Supplementary Medical Insurance (SMI) program for the twelve months beginning July 1982. It also announces the monthly SMI premium rate to be paid by all enrollees during the twelve months beginning July 1982.

Risk and safety assessment in child welfare: instrument comparisons.

The assessment of risk is a critical part of child welfare agency practice. This review of the research literature on different instruments for assessing risk and safety in child welfare focuses on instrument reliability, validity, outcomes, and use with children and families of color. The findings suggest that the current actuarial instruments have stronger predictive validity than consensus-based instruments. This review was limited by the variability in definitions and measures across studies, the relatively small number of studies examining risk assessment instruments, and the lack of studies on case decision points other than the initial investigation.

A methodological critique of the 'ideal weight' concept.

This article raises several objections to the procedures that were employed to determine ideal (optimal, desirable) weights in the 1959 and 1979 Build and Blood Pressure studies, the Framingham (Mass) study, and the recent study of the relationship between weight and mortality carried out by the American Cancer Society. The new height-weight tables based on the 1979 Build and Blood Pressure study are also criticized. The article concludes with the recommendation that the concept of ideal weight be abandoned and that attention be devoted to the morbidity and mortality experience of "outliers" (the very thin and the very obese).

Risk adjusting community rated health plan premiums: a survey of risk assessment literature and policy applications.

This paper surveys recent health care reform debates and empirical evidence regarding the potential role for risk adjusters in addressing the problem of competitive risk segmentation under capitated financing. We discuss features of health plan markets affecting risk selection, methodological considerations in measuring it, and alternative approaches to financial correction for risk differentials. The appropriate approach to assessing risk differences between health plans depends upon the nature of market risk selection allowed under a given reform scenario. Because per capita costs depend on a health plan's population risk, efficiency, and quality of service, risk adjustment will most strongly promote efficiency in environments with commensurately strong incentives for quality care.

Criteria of candidacy for unilateral cochlear implantation in postlingually deafened adults III: prospective evaluation of an actuarial approach to defining a criterion.

OBJECTIVE: Outcomes from unilateral cochlear implantation in postlingually deafened adults are variable and difficult to predict precisely from data gathered before surgery. The objective was to derive and validate a method for specifying criteria of candidacy for implantation that takes this variability into account. DESIGN: Accuracy of identifying words in prerecorded sentences without lipreading was measured in 480 users of unilateral multichannel cochlear implants. These patients had all scored zero before surgery on prerecorded open-set tests of word recognition in sentences with acoustic hearing aids. Statistical models were derived that calculated the odds that a patient would score higher with an implant than a criterion score, given knowledge of the duration of profound deafness in the implanted ear. The accuracy of the models was evaluated prospectively with two new groups of patients who scored between 1% and approximately 50% correct before surgery in one or both ears with acoustic hearing aids. Group I (N=53) was implanted in an ear that scored zero. Group II (N=31) was implanted in an ear that scored above zero. Benefits from implantation, measured as changes in word recognition performance and in health utility, were compared with the odds calculated by the statistical models. RESULTS: The preferred model was based on data from 376 subjects. It made accurate predictions of the proportion of patients in group I, and, disregarding minor exceptions, accurate predictions of the proportion of patients in group II, who improved on their preoperative word recognition score. Benefit from implantation was low for patients implanted with odds less favorable than 4:1 (4 chances out of 5). CONCLUSIONS: Adoption of odds of 4:1 as the criterion of candidacy for unilateral cochlear implantation would be likely to maintain acceptable benefit and cost-effectiveness while being explicit and informative for patients, clinicians, and commissioners of health care.