AMA Guides® Newsletter - Issue Archive

Articles

1. Fifth Edition: Asthma Impairment Evaluation

   James B. Talmage, Mohammed Ranavaya

   Pages 1–3

   DOI: 10.1001/amaguidesnewsletters.2001.MarApr01

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, uses approaches to respiratory system impairment rating that are similar to those of previous editions, with two significant changes: First, criteria for asthma impairment were updated to incorporate guidelines recently published by the American Thoracic Society (ATS), and, second, respiratory impairment criteria now incorporate the lower limit of normal for forced vital capacity, forced expiratory volume in the first second (FEV₁), and diffusing capacity for carbon monoxide. In 1993, the ATS published Guidelines for the Evaluation of Impairment/Disability in Patients with Asthma that recommended evaluating three parameters: degree of airflow limitation (postbronchodilator FEV₁); the degree of reversibility of the airflow limitation; and the minimum amount of medication needed to maintain maximal medical improvement (MMI). The ATS Guidelines contained a scoring system that was used to place the individual into one of six impairment classes. The Fifth Edition uses the same method of scoring the three clinical parameters and using the point score to determine which of the four impairment classes best describes the impairment. The Fifth Edition discussion of occupational asthma indicates the importance of removing the individual from further exposure to the sensitizing agent; MMI usually occurs within 2 years after removal from exposure.
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2. Impairment Tutorial: Respiratory System: Fifth Edition Redefines Normal

   James B. Talmage, Mohammed Ranavaya

   Pages 3–5

   DOI: 10.1001/amaguidesnewsletters.2001.MarApr02

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, changes the definition of “normal” (ie, the process of differentiating between an individual whose lung function is “normal” as opposed to an individual with Class 2 respiratory impairment) because the definition has changed over time. For example, the AMA Guides, First Edition (1971), used from the VA-Army 1961 Cooperative Study to construct tables of “normal” or “predicted” values during spirometry. Regression equations were used to calculate the predicted forced vital capacity, forced expiratory volume in the first second, and mandatory minute ventilation for men and women, by age and height. The Second Edition (1984) used data from a pulmonary function study in 251 healthy white individuals who lived 1400 meters above sea level (Utah), more than 90% of whom were members of the Mormon church (a very narrow segment of the American population). The AMA Guides, Third and Fourth Editions, continued to rely on the study just cited and made a distinction between “normal” and “mildly impaired.” The AMA Guides, Fifth Edition, uses the four classes of respiratory impairment and the same whole person impairment ratings for each class, unchanged from the Fourth Edition. The Fifth Edition has reverted to using the 95% confidence interval to determine “normal,” so that the same individual who, under the Fourth Edition guidelines was up to 25% impaired, would become normal under the pulmonary impairment guides of the Fifth Edition.
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3. Tools and Resources: Web Sites of Interest

   Christopher R. Brigham

   Pages 6–8

   DOI: 10.1001/amaguidesnewsletters.2001.MarApr03

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, explains that independent medical evaluations (IMEs) are not the same as impairment evaluations, and the evaluation must be designed to provide the data to answer the questions asked by the requesting client. This article continues discussions from the September/October issue of The Guides Newsletter and examines what occurs after the examinee arrives in the physician's office. First are orientation and obtaining informed consent, and the examinee must understand that there is no patient–physician relationship and the physician will not provide treatment bur rather will send a report to the client who requested the IME. Many physicians ask the examinee to complete a questionnaire and a series of pain inventories before the interview. Typical elements of a complete history are shown in a table. An equally detailed physical examination follows a meticulous history, and standardized forms for reporting these findings are useful. Pain and functional status inventories may supplement the evaluation, and the examining physician examines radiographic and diagnostic studies. The physician informs the interviewee when the evaluation is complete and, without discussing the findings, asks the examinee to complete a satisfaction survey and reviews the latter to identify and rectify any issues before the examinee leaves. A future article will discuss high-quality IME reports.
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4. Common Tips for IMEs (Part 3): Perfecting the IME Process: Evaluation

   Christopher R. Brigham, Leon H. Ensalada

   Pages 9–12

   DOI: 10.1001/amaguidesnewsletters.2001.MarApr04