Pattern and content of neuropsychological referral questions across 25 years of outpatient visits in a hospital-based clinic.

Abstract

Much of the practice of clinical neuropsychology is performed in the role of consultant and although the neuropsychologist is dependent upon referrals made from outside sources, relatively little attention has been devoted to the investigation of the referral process. Surveys of clinicians and referral sources have reported breakdowns of referral sources by discipline and general topics of referral questions based on recollection, but direct analysis of referral patterns across the same period has not been undertaken. By examining the referral questions rather than neuropsychologists" or referral sources" recollection of referrals, this study expands what is known about referral content and patterns. To date, no other study has examined the content of referral questions to investigate the practice of clinical neuropsychology. In an effort to explain question content without relying upon recollection, a coding rubric was designed to capture the breadth of presenting problems and requests seen in the original referral questions. Two-thousand-six-hundred referral questions were selected from the odd year over the 25 year period from 1983 to 2007, yielding a total of 2600 referral questions. Cochran"s Kappa was used to conduct interrater reliability analyses in three stages across the entire rating process. Content analysis showed that 79.1% of all questions had at more than minimal content. The most common request was for assistance with diagnostic considerations, which was present in 66.4% of all cases. Assistance with differential diagnoses was requested in 27.4% of all cases with the majority of these composed of requests for assistance in differentiating between psychiatric and neurological or other medical considerations. There was evidence for a trend over time 14. The Five Most Common Presenting Problems .

Four- and five-factor models of the WAIS-IV in a clinical sample: Variations in indicator configuration and factor correlational structure.

“…In contrast, only 5.4% of their sample had traumatic brain injury (TBI), 9.0% had major depressive disorder, 4.1% had mild cognitive impairment, and 1.9% had probable mild dementia or Alzheimer's disease. This suggests limited generalizability to many outpatient neuropsychology settings, where base rates of cognitive and psychiatric disorders tend to be significantly higher (Hopps, 2009).…”