Health Outcome Data Evaluation Decision Tree

This decision tree asks six specific questions to help health assessors determine whether a health outcome data evaluation should or could be done for evaluating site-related exposures. Health assessors will take different paths along the decision tree depending on whether they answer yes or no to each question.

Question 1: Completed or potential exposure pathway? If the answer is no, an arrow goes to a box that says to explain how ATSDR uses health outcome data and the criteria and rationale considered in determining whether a health outcome data evaluation would enhance the public health assessment decision-making process. You may consider other follow-up activities by ATSDR or other health agencies. This also connects to a box that indicates there is no health outcome data evaluation.

Question 2: Determined time of exposure? If yes, continue to question 3. If no, no health outcome data evaluation.

Question 3: Quantified exposed population? If yes, continue to question 4. If no, no health outcome data evaluation.

Question 4: Sufficient exposure levels and latency? If yes, continue to question 5. If no, no health outcome data evaluation.

Question 5: Health outcome data at a similar geographic scale as the exposed population? If yes, continue to question 6. If no, it goes to box that asks if you should consider other follow-up activities by ATSDR or other health agencies? If no, no health outcome data evaluation. If yes, recommend or conduct appropriate follow-up health activities.

Question 6: Health outcome data available for outcomes of interest? If yes (this means all six questions were yes), consult an epidemiologist or statistician to see if conducting a health outcome data evaluation is feasible. If no, it goes to box that asks if you should consider other follow-up activities by ATSDR or other health agencies? If no, no health outcome data evaluation. If yes, recommend or conduct appropriate follow-up health activities.

There is a footnote on the diagram that says: During the PHA process, health assessors will use the answers to the questions in this decision tree as a guide in determining whether a HOD analysis is possible and appropriate for their sites.