AMA Guides® Newsletter - Issue Archive

Articles

1. Comparative Analysis of AMA Guides Ratings by the Fourth, Fifth, and Sixth Editions*

   Christopher R. Brigham, Craig Uejo, Aimee McEntire, Leslie Dilbeck

   Pages 1–7

   DOI: 10.1001/amaguidesnewsletters.2010.JanFeb01

   Abstract

   In December 2007, the American Medical Association published the sixth edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), following previous editions published in 2000 (fifth edition) and 1993 (fourth edition). To assess the effects of changes in whole person impairment ratings across editions, the authors selected 200 cases of whole person impairment and reevaluated each according to criteria in the three editions. Interrater reliability was confirmed when an independent reviewer checked 15% of the cases and found agreement within 1% in all but one of the thirty cases checked. Tables and figures in the article compare average whole person impairment in terms of sixth edition chapters; by edition; and by category (nonsurgical vs surgical intervention) and edition. On the basis of the sample and their comparisons, the authors conclude that the effect for patients based on their diagnostic impairment is small, and greater difference is seen for results obtained using the fifth edition compared with the fourth edition. The observed changes were expected and result primarily from the following: surgery and therapy should improve function and thus should not routinely increase impairment; there are improved functional outcomes for carpal tunnel syndrome and total joint replacement; and certain common conditions that resulted in functional deficits but no ratable impairment in previous editions now should be ratable. The study showed excellent interrater reliability with sixth edition ratings, which was an important goal for the new edition.
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2. Guides Question and Answer

   James B. Talmage

   Pages 7–7

   DOI: 10.1001/amaguidesnewsletters.2010.JanFeb02

   Abstract

   Sun-related skin disorders are rated, along with all dermatological disorders, using Chapter 8, The Skin, in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) and are based on three factors: the presence of a skin disorder (signs and symptoms); need for treatment; and interference with activities of daily living (ADL). This Case Presentation illustrates some of the challenges that an evaluator new to the rating process may encounter and clarifies that precautionary guidance to reduce sun exposure is not equivalent to interference in ADL and the assignment of impairment. The patient has been a firefighter since 1986, previously worked in construction, lives in Southern California, and surfed recreationally until six or seven years ago. He presents with new lesions of his skin following sun exposure and has been followed by his primary care physician and his dermatologist regarding his basal cell carcinoma and cryosurgeries to treat actinic keratoses. The evaluator determines class 3, 25% impairment, which precludes ADL in the midday sun. The authors note two immediate red flags: Misnaming the AMA Guides is a typical beginner's error, and the evaluation provides no reference to specific criteria or tables even though the State of California uses the fifth edition to rate workers’ compensation cases.
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3. Rating Sun-Related Skin Disorders

   Christopher R. Brigham

   Pages 8–11

   DOI: 10.1001/amaguidesnewsletters.2010.JanFeb03