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IN-DEPTH STUDY

MEETING WITH EXPERTS

Method

A blend of licensing officials and medical personnel from 11 jurisdictions met in Washington, DC to address barriers to implementing the components emerging from the RVA as being most important. Jurisdictions were chosen with input from AAMVA, NHTSA, and TransAnalytics staff to provide diversity in terms of size, geographic area, AAMVA Region, number of drivers, scope of current medical review activities, and perceived interest in exploring innovative practices to meet future safety needs and customer service goals.

The 11 jurisdictions chosen included: District of Columbia, Florida, Iowa, Maryland, North Carolina, Ohio, Oregon, Utah, Virginia, Washington, and Wisconsin. Key attributes of the jurisdictions chosen to attend the meeting are contrasted in table 6. Fifteen representatives (10 administrative and 5 medical) from the 11 jurisdictions participated, along with 3 NHTSA staff, 1 AAMVA staff member, and 2 TransAnalytics staff. The meeting was audio-recorded and later transcribed by Caset Associates. The agenda was organized into three areas: introductions by meeting attendees; a description of the project history and findings to date; and a round-table discussion of best-practice recommendations and barriers to their implementation. The list of meeting attendees is presented in Appendix C.

Table 3. Results of Relative Value Assessment Exercise (Calculated Weights).

Mean Weights Across States (n=45)
%
%
%
30 [A] Policies governing medical review activities 9.58 [F] Comprehensiveness of criteria for licensure 2.72 [Z] Standards for blackouts/seizures/losses of consciousness (includes mental disorders & dementia)
2.67 [Y] Standards for vision
2.37 [AA] Standards for medical conditions affecting multiple body systems (e.g. for heart, lung, endocrine musculoskeletal, etc)
1.84 [AB] Standards for alcohol/substance abuse




7.63 [E] Nature/extent of DMV Medical Advisors' mission 3.10 [U] Develop medical criteria/guidelines for licensing
2.17 [V] Review individual cases
1.24 [X] Develop report forms
1.14 [W] Hear appeals
7.62 [H] Physician reporting responsibilities and protections 2.70 [AH] Protection from tort action/immunity for reporting
2.18 [AI] Mandated by law for specified medical conditions
1.61 [AG] Confidential
1.15 [AJ] Sanctions for failure to report




7.62 [G] Due process for drivers referred for medical review 1.58 [AE] Road test
1.16 [AC] No anonymous reports
1.15 [AD] Follow up of reporting source to validate claim
1.06 [AF] Appeal of departmental action




29 [B] Process for identifying at-risk drivers 9.15 [L] Use of external, medical triggers for medical reviews 3.24 [AW] Personal physician
2.61 [AZ] Vision care specialists
1.91 [AY] OT/driving evaluators
1.39 [AX] Hospital discharge planners




7.44 [I] Extent of DMV testing for license renewal 2.20 [AK] Vision
2.13 [AM] Road
1.72 [AN] Functional screening
1.40 [AL] Knowledge




7.26 [K] Use of external, non-medical triggers for medical reviews 2.45 [AS] Law enforcement/courts
2.06 [AT] Family
1.71 [AV] Social services (includes geriatric evaluation)
1.05 [AU] General public




5.46 [J] Use of internal triggers for medical reviews 1.58 [AP] Observations by counter staff
1.53 [AO] Self reports
1.32 [AQ] Driving history (points, crashes)
1.05 [AR] Age




24 [C] Case review procedures
7.55 [O] Use of external evaluation procedures 2.48 [BJ] Examination by personal physician
2.32 [BK] Examination by medical specialist (e.g., Neurologist)
1.68 [BI] Driving evaluation (driver rehabilitation or driver training specialist (OT/CDRS, driving school)
1.09 [BL] Clinical/laboratory testing




6.75 [N] Extent of DMV evaluation procedures 2.14 [BH] DMV examination (may include vision, knowledge, and/or road)
2.10 [BF] Request for and review of medical history
1.42 [BG] Functional screening
1.10 [BE] Interview (in-person or video)




4.66 [M] Availability of options for preliminary disposition (determines path for evaluation) 1.39 [BC] Assignment by non-medical staff (administrative determination via procedure manual, checklist)
1.28 [BB] Assignment by medical staff advisor (e.g., nurse case worker, on-staff or physician consultant)
1.06 [BA] Hearing officer interview with driver
0.94 [BD] Voluntary surrender




4.54 [P] Composition of Medical Advisory Board 1.23 [BO] Paid consultants
1.16 [BP] Voluntary consultants
1.11 [BN] Part-time DMV staff physicians
1.06 [BM] Full-time DMV staff physicians





[D] Options supporting continuing safe mobility 5.09 [Q] Availability of restrictions for license "customization" 1.74 [BQ] Daylight/time of day
1.26 [BR] Geographical (e.g., radius of home, within city limits, not in city limits)
1.25 [BT] Road class exclusion (e.g., no freeways, no roads with speeds of 45 mph or greater)
0.84 [BS] Specific routes or destinations




5.01 [T] Scope of DMV staff training 1.40 [CE] License examiners (to conduct specialized road tests)
1.34 [CD] License examiners (to conduct functional screening)
1.24 [CC] Counter staff (to recognize signs of functional impairment)
1.02 [CF] Sensitivity training for issues relating to senior drivers & drivers with disabilities




3.79 [S] Breadth of outreach activities by DMV 1.12 [BY] Physician education
0.99 [CA] Law enforcement training in signs of impairment
0.85 [CB] Other agencies providing services to seniors
0.84 [BZ] Public awareness/injury prevention




3.54 [R] Type/extent of referrals for at-risk drivers 1.05 [BX] Retraining/"skills refresher"
0.87 [BV] Remediation (to correct or ameliorate functional deficits)
0.87 [BW] Alternative transportation
0.76 [BU] Counseling (for adjustment to change in license or functional status)
100
100
100


Table 4. Rank Ordering of the 16 Components from Column 2 of the
Relative Value Assessment Exercise.

Medical Review Component
Weight
Rank
F
Comprehensiveness of Criteria for Licensure
9.58
1
L
Use of External, Medical Triggers for Medical Review
9.15
2
E
Nature/Extent of DMV Medical Advisors’ Mission
7.63
3
H
Physician Reporting Responsibilities and Protections
7.62
4
O
Use of External Evaluation Procedures
7.55
5
I
Extent of DMV Testing for License Renewal
7.44
6
K
Use of External, Non-Medical Triggers for Review
7.26
7
N
Extent of DMV Evaluation Procedures
6.75
8
J
Use of Internal Triggers for Medical Reviews
5.46
9
Q
Availability of Restrictions for License Customization
5.09
10
T
Scope of DMV Staff Training
5.01
11
G
Due Process for Drivers Referred for Medical Review
4.95
12
M
Availability of Options for Preliminary Disposition (Determines Path for Evaluation)
4.66
13
P
Composition of MAB
4.54
14
S
Breadth of Outreach Activities by DMV
3.79
15
R
Type/Extent of Referrals for At-Risk Drivers
3.54
16


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