Assessing Your Health

Health assessment tools can help you and your provider to better understand and quantify your risk for specific diseases, and establish goals and strategies for better health.

The four main types of assessment tools used at Duke are:

Learn more about each type in the sections below.

Health Assessment

Much of health care today focuses on controlling or preventing chronic disease. Physicians are trained to focus upon objective measures of disease that are known to improve mortality and reduce health care costs, but do not necessarily reflect what is important to the patient.

Health assessments are designed not to calculate risk for a specific disease, but to assess markers of the patient’s well-being--such as quality of life, functional status (ability to perform normal activities), satisfaction with health status, health-related goals, and intention to change health-related behaviors.

Combining these patient-centered measures with other traditional measures of health helps providers and patients to better communicate with each other, and gives providers the information they need to help motivate patients to change unhealthy behaviors.

There are many standardized surveys available which measure different aspects of the health assessment. One example is the SF-12, a 12-item questionnaire assessing current quality of life, which is widely used in Duke orthopaedic and cancer clinics before and after treatment.

Disease Risk Assessment

Disease risk assessments use an individual’s personal, genetic, and environmental information to determine a quantitative or qualitative value of risk for developing specific diseases such as breast cancer, diabetes, or osteoporosis.

The tools calculate a personalized risk assessment "score" based on individual risk factors such as diet, exercise, smoking, alcohol consumption, family history, DNA, and biomarkers (blood tests, functional tests, or imaging tests that reflect normal physiologic or pathologic processes—such as blood sugar and blood pressure levels).

These risk assessment scores are the end product of research studies looking at the contribution of individual risk factors for each disease state. For example, the Framingham Study identified several risk factors for the development of heart disease. It did this by collecting data on a large number of individuals living in Framingham, Massachusetts over a period of decades. At the end, researchers were able to statistically compare information from those who had heart attacks to those who did not, to identify which items were important risk factors for developing a heart attack.

The Framingham risk calculator combines age, gender, smoking status, and cholesterol to generate a risk score for heart disease.  These numbers allow both the patient and the physician to objectively determine where a patient’s current health status is compared to the general population and to their personal goal.

Changes in risk assessment scores over time can show the positive and negative impact from modifiable behaviors. In our example above, if a patient lowered his/her cholesterol through diet and exercise, the change in the Framingham score would provide objective feedback on how behavior has improved their health risk.

Risk reporting

Risk scores can now be calculated for a long list of diseases, although some tools have been more rigorously studied than others. Each risk assessment model can calculate a score for an individual disease and each can present risk scores in different formats, including:

  • Absolute risk (i.e. your risk of heart attack in 10 years is x%)
  • Relative risk (i.e. your risk is three times higher than the average person your age)
  • Modifiable risk (if you stop smoking you will lower your risk by x%)

How your risk is reported depends upon the risk calculator used.

Examples of risk calculators

Tools currently in use at some Duke clinics include the following:

Your provider can determine whether these tools may be helpful to you and ensure an accurate interpretation of results.

Family Health History

Family health history (FHH) is a unique disease risk assessment tool based on information about health conditions that affect members of your family.

Within families, blood relatives share similar environments, lifestyles, and genetic backgrounds. As a result, FHH reflects the complex combination of all these factors on an individual's risk for developing health conditions.

In fact, FHH is the most powerful medical tool available for identifying individuals at increased risk for common, complex diseases such as cancer, heart disease, diabetes, and others.

For instance, research has shown that people who have a sibling or parent with type 2 diabetes have more than double the risk of getting the disease themselves. For coronary artery disease, your risk doubles when even just a second-degree relative—an uncle or grandparent—has the condition and, in the case of many cancers such as colon, breast or prostate cancer, having one affected sibling or parent almost doubles your risk.

Although most individuals believe that knowing their family history is important to their personal health, the majority never collect, record, or share this information.

To encourage more people to take advantage of this powerful tool, the Department of Health & Human Services has launched a Family History Initiative and the U.S. Surgeon General has declared that Thanksgiving Day also be known as National Family History Day. The free, online tool, My Family Health Portrait, was created to help people collect and store their family information. In addition, the Centers for Disease Control (CDC) has created a Family History topic page with multiple links to information about family history with resources for the public and health professionals.

Resources from Duke

To increase awareness of family history among Duke employees, the Duke Institute for Genome Sciences & Policy (IGSP) and LIVE FOR LIFE teamed up to provide customized booklets about family health history to Duke employees.  Made possible through a grant from the Genetic Alliance, the set of two booklets, called "Does It Run in the Family?" was originally created by the Genetic Alliance through the Community Centered Family Health History project.

Although initially designed for Duke employees, anyone can use the booklets and share them with their family and friends.

Family Health History Guides:

Genetic & Genomic Risk Assessment

Your DNA can provide valuable information about your risk for disease and prognosis after disease.

Full-genome risk assessments, currently available through Duke Executive Health, analyze your unique genetic code for a wide range of mutations associated with both common and rare diseases. Genetic tests are also available to examine specific genes for mutations associated with disease risk.

While these tests can also be purchased commercially, they do not give a complete picture of risk, so Duke offers expert counseling to help you put the results in context and learn what you can do to stay healthy.

Learn more about genomic and genetic testing at Duke