IN-DEPTH STUDY

MEETING WITH EXPERTS

Results

The results of the Relative Value Assessment (RVA) exercise formed the starting point for the discussions. These discussions were summarized in detail in a separate task report submitted to NHTSA. A more limited summary follows, focusing on the top half of the components listed in table 5, plus highlights from the bottom half of the table when a particular component, though lower-ranked, still received considerable discussion.

Table 5. Rank Ordering of the 64 Components from Column 3 of the Relative Value Assessment Exercise.

Table 6. Contrast Among Jurisdictions Selected to Attend Task 8 Meeting.

Meeting discussions began at the most general level of the RVA—components A-D. High weights assigned to components at this level had the effect of producing high weights for the subcomponents at the third level of this weighting exercise. Conversely, low weights assigned to components at this level produced low weights for the subcomponents at the third level. Within the four broad categories that describe medical review activities, the 45 respondents weighted policies governing medical review activities (component A) and processes for identifying at-risk drivers (component B) as nearly equally important (at 30 and 29, respectively), and as the two most important areas in a model medical review program.

This result was considered intuitive by meeting attendees, because first and foremost in a medical program, methods for identifying potentially at-risk drivers and guidelines and procedures for determining medical and functional fitness to drive for this population must be in place. The RVA respondents rated case review procedures (component C) as third in relative value, with a weighting of 24, and options supporting continuing safe mobility (component D) as fourth in relative value, with a weighting of 17.

In addition to being rated as most important in a model medical program, policies governing medical review activities received considerable attention during the meeting. Several attendees said policies are so important to DMVs because they must ensure that drivers are being treated with consistency to avoid tort litigation. Policy is also important in determining how fitness to drive is defined (medical criteria and standards); whether a jurisdiction has a Medical Advisory Board and what medical specialties must be represented by the physicians on the board; physician reporting responsibilities and protections; and procedures for license renewal testing and renewal cycles. It is clear from the Relative Value Assessment exercise and discussion that followed, that policy was rated as the most important of the four components because it sets the tone for the entire medical review process.

Meeting participants were asked to comment on the low rating given to options supporting safe mobility. This was highlighted for discussion in light of the fact that NHTSA, as well as several States, have acknowledged that not only identifying at-risk drivers but also keeping people driving safely longer are both important components of medical review programs. In a broad-based program where the welfare of the individual is a priority—in addition to public safety—all four general components in the first column would, hypothetically, be equally weighted at 25. Options supporting continuing safe mobility received a relative value of only 17.

A physician in attendance remarked that, for the four broad components to be considered equally important, the DMVs’ missions must be “to keep people on the road as long as they can be safe” instead of just “public safety.” Meeting attendees explained the various reasons that options supporting safe mobility may have been weighted lower in their jurisdictions. Reasons included the fact that this is a new concept for several jurisdictions, and they have just begun to explore how to implement activities such as public information and education; counseling and referral for remediation/retraining or to alternative transportation; and education of physicians, law enforcement, etc. Traditionally, the DMV mission has been highway safety—get the unsafe driver off of the road. Even though a DMV may want to help people and provide options, providing options for continued safe mobility does not presently hold the same importance as highway safety.

Another reason for the low rating is that in many places, some of the options are limited, such as alternative transportation in rural communities.

Other jurisdictions explained that the DMV does not explicitly get involved in these activities, but joins with other agencies and supplies drivers with information about the services provided by the partnering agencies. So it is not the case that DMVs place a low level of importance on options for supporting safe mobility but instead they “hand off” many of these activities to organizations better equipped to provide such support. A comment was made that in order for information about where to go for help to be of use to an individual, lists of services must be local/community-based and not State-based.

One point that was made and agreed upon by most in attendance was that if the approach to medical review were balanced across all four components (expressed as “ the right way”), it would be cost effective in the long run, even though it may be more costly in the beginning. It was also mentioned by one meeting attendee that it should not be difficult to get all the DMVs to include options for supporting continuing safe mobility in their mission statements, as all DMVs want to keep people driving as long as they can do so safely.

The remaining summary of meeting discussions in this section is organized loosely in terms of the ranking of the top half (highest weighted 32 components) of the RVA, including meeting participants’ comments regarding recommended strategies and barriers to their implementation. Where substantial time was devoted in the meeting to discussion of components ranked in the bottom half of the RVA, comments are provided where discussion of these points is logical within the context of a model medical review program.