Hospital Service Utilization is Reduced Following Neuropsychological Evaluation in a Sample of U.S. Veterans

Abstract

The aim of this study was to evaluate the objective value of neuropsychological evaluation (NPE) through reduction in Emergency Room (ER) visits and hospitalizations. Retrospective analysis examined trends in ER visits and hospitalizations in 440 U.S. veterans who completed NPE between the years of 2003 and 2010. Within-subjects comparisons showed significant decreases in incidence of hospitalization and length of hospitalization in the year after evaluation compared to the year prior. Mean number of hospitalizations declined from 0.31 (SD = 0.64) pre-NPE to 0.22 (SD = 0.59) post-NPE; there were a total of 41 fewer hospitalizations in the year following NPE. Mean length of hospitalization decreased from 1.9 days (SD = 5.6) pre-NPE to 1.06 days (SD = 3.9) post-NPE; there were a total of 368 fewer days of hospitalization post-NPE. This reduction was not attributable to age or time. Incidence of ER visits also decreased from pre-NPE (M = 0.74, SD = 1.3) to post-evaluation (M = 0.69, SD = 1.3), though this was not significant. These findings provide preliminary evidence of the clinical and potential economic value of neuropsychological services within a medical setting. Follow-up studies should examine individual and exam-specific factors that may contribute to reduced utilization.

The utility of neuropsychological consultation in identifying medical inpatients with suspected cognitive impairment at risk for greater hospital utilization

“…Incidence of ER visits also decreased from pre to post-evaluation, though it was not significant. These findings provide preliminary evidence of the clinical and potential economic value of outpatient neuropsychological services within a medical setting (VanKirk, Horner, Turner, Dismuke, & Muzzy, 2013).…”

“…Table 3 details the type and percentages of medical comorbidities present across the total sample and each group. The number of medical comorbidities was coded to emulate the “number of dysfunctional bodily systems” categories used by VanKirk, Horner, Turner, Dismuke & Muzzy, 2013. Each bodily system/medical comorbidity category received a binary score of 1 or 0.…”

“…Within the field of neuropsychology, even earlier in the era of healthcare reform, Prigatano and Pliskin (2003) argued for the incorporation of healthcare economics models into research demonstrating the efficacy and utility of neuropsychological services. There continues to be strong support and calls for documenting the utility of neuropsychological services in order to advance and adapt neuropsychological practice to the modern healthcare environment (Chelune, 2010; Goldstein, 2010; Kubu, Ready, Festa, Roper, & Pliskin, 2016; Prigatano & Morrone-Strupinsky, 2010; VanKirk, Horner, Turner, Dismuke, & Muzzy, 2013).…”

“…One study, VanKirk, Horner, Turner, Dismuke, and Muzzy (2013), sought to evaluate the objective value of outpatient neuropsychological evaluation through reduction in Emergency Room (ER) visits and hospitalizations in a sample of 440 US Veterans. Within-subject comparisons showed significant decreases in incidence of hospitalization and length of hospitalization in the year after outpatient neuropsychological evaluation compared to the year prior that was not attributable to age or time.…”

President’s Annual State of the Academy Report

“…The grants made by the Foundation, listed below, total over $100,000 in awards. To date, two publications have emerged from AACNF grants, and have both been published in The Clinical Neuropsychologist (Pritchard, Koriakin, Jacobson, & Mahone, 2014;VanKirk et al, 2013). Beginning in 2011, AACNF sponsored an 'Opening Night' benefit for the Foundation, held in conjunction with the annual AACN Conference.…”