The objectives of this project were as follows:
The research products include reports summarizing key project activities, described below, plus recommendations for licensing agencies for the identification, assessment, and disposition of drivers with medical conditions and functional impairments, and related customer service goals.
The information obtained about medical review practices in the 51 driver-licensing agencies in the United States was obtained through requests of licensing officials to complete a survey, and then to participate in a follow-up telephone interview with the project principal investigator at TransAnalytics to clarify and expand the responses. The survey was developed jointly by the American Association of Motor Vehicle Administrators (AAMVA), the National Highway Traffic Safety Administration (NHTSA), and TransAnalytics project staff. The data collection instrument was designed using the information about drive-licensing medical review practices presented in AAMVA (1999) and Petrucelli and Malinowski (1992) as a starting point.
The survey was mailed by AAMVA, under cover signed by the AAMVA senior vice president of the Programs Division. Survey respondents were asked to mail forms, guidelines, and statutes used in their medical program operations. As surveys were received by the project principal investigator, quantitative data were entered into summary tables and qualitative data were reviewed for thoroughness. Survey respondents were then telephoned by the principal investigator, and asked to provide more detail for identified survey questions. Information obtained from the three sources (telephone conversations; the written survey responses; and State guidelines, procedures, and statutes) was used to produce a narrative detailing the procedures employed in each jurisdiction for dealing with drivers who have functional impairments and medical conditions. The draft narratives were e-mailed to the survey respondents, who reviewed the information for errors or omissions. Respondents’ comments were incorporated into the final narratives, which along with three appendices of summary tables, comprise the project deliverable titled, Summary of Medical Advisory Board Practices in the United States. This research product is posted on AAMVA’s Web site at the following address:
An in-depth study was conducted next, to determine which activities currently applied by one or more driver-licensing agencies in the United States deserve priority for consideration as recommended strategies, and to provide suggestions that may facilitate the implementation of the recommended strategies. Two activities were undertaken to assist in this determination:
The first of these activities involved 45 of the 51 licensing jurisdictions, sampled through a mailed survey to key licensing officials and medical staff. The second was accomplished through a 1½-day meeting held in Washington, DC, that included representatives from NHTSA and AAMVA; TransAnalytics project staff; and medical review staff from a subset of States chosen with the assistance of NHTSA and AAMVA. The 11 jurisdictions represented at the meeting included: the District of Columbia, Florida, Iowa, Maryland, North Carolina, Ohio, Oregon, Utah, Virginia, Washington, and Wisconsin.
The Relative Value Assessment (RVA) exercise involved an assignment of weights among related groups of potential components of a medical review program, to determine how important each component is in relationship to the other components in the group. Representatives from all 51 jurisdictions sampled in the earlier survey conducted in this project were contacted again through AAMVA with a request to participate in the RVA exercise. As the first step in developing the RVA, medical review program components were identified as viable candidates for driver medical review recommended strategies. This was done through review of the project deliverable titled Summary of Medical Advisory Board Practices in the United States by the TransAnalytics principal investigator and senior analyst. Sixty-four candidate recommended strategies were identified. These components were arranged in a hierarchy, moving from the most general to the most specific. Respondents were asked to assign weights to subsets of medical review program components, at each level of the hierarchy. Instructions emphasized that when assigning relative values to each set of components, respondents should consider only how important each component element would be to the success of a model medical evaluation program, without regard to current feasibility of implementation.
Licensing agency medical review department personnel in 45 jurisdictions completed and returned RVA exercises. Mean weightings were calculated and were used to help pinpoint which components are considered most important to the effectiveness of a model medical review program. Components with high weightings were used as the starting point in discussions with licensing agency personnel and NHTSA and AAMVA representatives at the 1½-day meeting to identify recommended strategies and barriers to their implementation.
The meeting began with a brief overview of project activities conducted to date and a discussion of the RVA exercise outcomes. The meeting then moved into a round-table format with discussions about what constitutes recommended strategies among the 64 components rated in the RVA and what legislative and budgetary barriers could preclude implementation.
A true consensus regarding recommended strategies for most medical program components discussed at the meeting was rarely achieved; however, substantial agreement among participants was reached on the following points:
Conclusions from the meeting with experts and outcomes from the RVA exercise serve as the rationale for development of recommended strategies for the identification, regulation, and continuing safe mobility of drivers with medical conditions and functional impairments.
This report summarizes the activities conducted in this project. Recommendations for a model medical review programgiven realistic constraintsare presented at the end of this report. It should be noted that, while this report includes recommendations for recommended strategies, and attempts to identify key barriers to their implementation, it was beyond the scope of this project to address any timelines for implementing recommended practices. Also, while participating physicians advised the project team that State attorneys general have in some cases ruled that a Motor Vehicle Administration/Department of Motor Vehicles is exempt from the Health Insurance Portability and Accountability Act (HIPAA) to the extent that the public welfare depends upon its medical review of drivers, this report does not explicitly address the issue of whether compliance with this or other regulations will or will not be an issue in a given jurisdiction.