AMA Guides® Newsletter - Issue Archive

Articles

1. International Classification of Functioning, Disability, and Health: A Contemporary Model of Disablement

   Malcolm Bond

   Pages 3–8

   DOI: 10.1001/amaguidesnewsletters.2015.JulAug01

   Abstract

   This article begins with a consult of a patient using the International Classification of Functioning, Disability, and Health (ICF), published by the World Health Organization in 2001. The ICF framework serves as the conceptual model for the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. In contrast to the issues of morbidity-centric documentation schemas, the ICF platform provides a standardized nomenclature to chart functioning, specifically an integrative biopsychosocial model of functioning that defines the components of functioning. The ICF qualifier serves as the titratable dimension of function; the qualifier not only satisfies the need for charting progress but also, when aggregated, provides the possibility of identifying the quantitative metrics of a cohort (eg, service needs, length of hospitalization, level of care, functional outcomes, and return-to-work potential). Implementing ICF into routine documentation moves practitioners toward the concept of functioning not as a consequence of disease but rather toward the real-life dynamics among health condition, body function, body structure, and environmental factors that determine functioning. ICF will be an essential basis for the standardization of data concerning all aspects of human functioning and disability around the world. ICF will be useful for persons with all forms of disabilities, not only for identifying health care and rehabilitative needs but also in identifying and measuring the effect of the physical and social environments.
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2. Apportionment of Medical Illness

   Stephen L. Demeter, E. Randolph Soo Hoo

   Pages 9–16

   DOI: 10.1001/amaguidesnewsletters.2015.JulAug02

   Abstract

   Apportionment sometimes is necessary when a person had a prior injury that affected the same organ system or when there was evidence of a pre-existing disorder that was similar to the injury that will be rated. The past three editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) include subtle differences in the way that apportionment is defined. In addition to the information provided in the appropriate edition, certain philosophical and mechanistic considerations should be assessed before any apportionment and then should be used consistently in any subsequent cases that require apportionment. The first step in apportionment is a scientifically based causation analysis. Evaluators must avoid arbitrary, opinion-based unscientific apportionment estimates that are little more than speculations. In a situation that involves multiple injuries, if the impairment assessment has reached a defensible position with respect to causation then the rating for the first injury is determined using the edition of the AMA Guides that was used to rate the second injury. For example, if the rating for a second injury will be determined using the sixth edition, then the data for the first injury should be reworked using the sixth edition rules, irrespective of the rating for the first injury and the edition that was used.
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