Appendix

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Appendix A. Combined Values Chart

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Combined Values Chart

Appendix B. Burden of Treatment Compliance

The burden of treatment compliance (BOTC) is assessed via a point system, which is then converted to an impairment percentage. Points are assigned on the basis of:

  1. Medication usage, per medication, dependent upon the route and frequency.

  2. Dietary modifications.

  3. Frequency of routinely performed procedures

  4. History of prior operative procedure or radiation therapy.

These points are then converted into impairment based upon Table B-1.

Table B-1

Burden of Treatment Compliance

Total Points Impairment (%)
0–1 0
2–5 1
6–10 2
11–15 3
16–20 4
21–25 5
26–30 6
31–35 7
36–40 8
41–45 9
46 + 10

In most situations, BOTC will not result in the addition of more than 2% to 3% impairment. In chapters using BOTC, points are to be added onto final impairment rating.

Medication Usage

Perform the following analysis to determine the point score that will be used in calculating the BOTC due to medication usage.

  1. Assess the dosing frequency and route of administration for each medication used for the condition being rated, and assign points for each using Table B-2a for oral, inhaled, ocular, skin and rectal medications, and Table B-2b for medications administered by an intravenous, subcutaneous, intramuscular, intradermal, or intracavitary route.

  2. Add these to get the total points for medications.

Table B-2a

Oral, Intranasal, Ocular, Skin

Dosing Frequency Points
< 1 per day 0
1 to 2 per day .5
3 to 4 per day 1.0
5 to 6 per day 2.0
> 6 per day 3.0
Table B-2B

Inhaled, Rectal

Dosing Frequency Points - Inhaled Points - Rectal
< 1 per day 0 1.0
1 per day 1.0 2.0
2 per day 2.0 4.0
3 per day 3.0 6.0
≥ 4 per day 4.0 8.0

Table B-2a and Table B-2b: Points for Frequency and Route of Medications—Per Medication

Notes:

  1. Combination medications are assessed by the total number of medications. For example, combinations of antihypertensives and diuretics count as two medications due to the potential side effects of each.

  2. Medications need to be taken chronically for a chronic condition specific to the organ systems under evaluation. If a medication is being used for two systems it should be counted only once. Each month is arbitrarily considered to be 28 days; the medication must be taken at least 21 days per month to count as a medication that is taken daily.

  3. Medications given to correct a well-documented side effect of a medication used to treat a condition specific to the organ system being rated are also counted unless:

    1. a. The medication side effect is not well documented by either its known pharmacologic actions or by a review of the individual's personal medical chart.
    2. b. The condition resulting from the side effect is rated in conjunction with providing a rating for an alternative and more appropriate organ system.
    3. c. The medication (either the primary medication or the medication used to counteract a side effect) is a non-prescription or alternative medication that is not prescribed by an allopathic or osteopathic physician.
  4. For “prn” – use average frequency based on use, although prn medications must be prescribed by a physician for a chronic condition (such as Imitrex for migraines).

Table B-2C

Points for Subcutanous, IM, Intradermal, IV, and Intracavitary Medication

Route of Administration Points
SC, IM, ID: 1 to 3 times weekly 1.0
SC, IM, ID: 4 to 7 times weekly 2.0
SC, IM, ID: 2 times a day 3.0
SC, IM, ID: 3 times a day 4.0
SC, IM, ID: 4 times a day 5.0
SC, IM, ID: 5 times a day 6.0
Intra-cavitary Reservoir Based on frequency that reservoir is filled
Intravenously 1 point per treatment per day up to 25 points/ month

Notes: Filling the reservoir once a month or more frequently is assigned 4 points; for filling once every 2–4 months, assign 2 points; for filling the reservoir less frequently, assign 1 point

Dietary Modification

Many conditions require dietary modification. The degree to which this is necessary varies from patient to patient, as does the degree to which patients comply with these restrictions. Thus, rather than build an allowance for this into the impairment rating, it appears more reasonable to rate it separately. BOTC points are given for dietary modification when the patient is compliant, and are based upon the premise that complying with dietary restrictions restricts ADLs in ways other than those measured by the history and medication use alone.

Table B-3

Points Assigned For Dietary Modification

Modification Points
Dietary modifications – Minimal 2.0
Dietary modifications – Moderate 5.0
Dietary modifications – Severe 10.0

Procedure-Based Impairment

Certain procedures are not routinely performed on all patients with a given disease. It is consequently unreasonable to assume a default level of impairment based upon the need to undergo these procedures in the rating assigned for these conditions. The need to have undergone procedures such as a laparotomy or radiation therapy for a condition also varies from patient to patient and contributes slightly to impairment. A schema for assigning procedural based impairment is as in Table B-4. Peritoneal dialysis, hemodialysis and ostomy-related impairment are sufficiently intrusive as to warrant the direct assignment of impairment percentages and are covered in specific organ-system chapters.

Table B-4

Points Assigned for Procedures

Procedure Points
Glucose monitoring: 1 times per day 1.0
Glucose monitoring: 2 times per day 2.0
Glucose monitoring: 3 times per day 3.0
Glucose monitoring: ≥ 4 times per day 4.0
Hemophoresis 4.0 per episode per month
Transfusion (monthly) 2.0 per unit per month
Exploratory laparotomy 2.0 (assigned only once)
Radiation therapy 2.0 (per body part irradiated)
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