Study finds 78 percent error rate in employee impairment ratings
The study, by Impairment Resources, examined ratings from eight states, with 81 percent of the cases being from California and 91 percent rated using the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fifth Edition. Currently, 16 states use the fifth edition while 10 use the sixth edition, 10 use earlier editions, and seven use state-specific guidelines. No guidelines are specified in the remaining states.
Researchers said that while not a random sampling -- all cases had been submitted for expert review -- the study sheds light on reasons for inaccuracy in impairment ratings, suggests areas for improvement, and echoes the findings of a similar study performed in 2005.
Among the highlights of the study, researchers found that:
- Non-AMA approaches result in more inaccuracies. Researchers said problems are more common in jurisdictions where physicians use approaches other than those specified by the AMA guides than in jurisdictions where physicians are trained, experienced, and perform in accordance with best practices.
- Variety of factors lead to inaccurate ratings. Most ratings were performed incorrectly, resulting in ratings averaging more than twice what was appropriate. The study concluded that inaccurate ratings are often the result of bias, confusion, and misapplication of the guides.
- Sixth edition is best choice. The study concluded that there are significant problems with interrater reliability with fifth edition ratings. Researchers said that preliminary data suggests that both the error rate and magnitude of error may be less with sixth edition ratings.
The study authors suggested stakeholders take steps to drive more accuracy in impairment ratings by ensuring that impairment ratings are performed by knowledgeable, skilled, and unbiased examiners with training in use of the guides, and that ratings are independently reviewed by personnel who are equally skilled and knowledgeable. In addition, the study recommended that clients requesting reviews should take a hands-on approach to reviewing physician credentials, defining standards, and supplying all relevant records, and that all stakeholders should advocate for adoption of the sixth edition, which is the most accurate and advanced standards.
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September 7, 2010
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