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CASE MANAGEMENT/COST EFFECTIVENESS ANALYSIS FOR RECOMMENDED NEUROPSYCHOLOGICAL SERVICES

Outcome is measured in different ways:

a. Medical services reduction.
b. Traumatic brain injury long-term needs.
c. Dementia-functional capacity, home or placement services.
d. Vocational/ Academic change after injury.
e. Disability analysis.
f. Neuropsychological independent living skills.
g. Outcomes also reflect quality of life variables.
h. Outcome can include larger psychosocial variables.

The question is whether to accept or reject neuropsychological services in the analysis of a case.

The following medical diagnostic conditions and endeavors provide an opportunity to demonstrate the value of neuropsychological case analysis while informing consumers and third party payers getting the most for today's limited healthcare dollars.

NEUROPSYCHOLOGICAL CONSULTATION AND CASE MANAGEMENT:

  1. The neuropsychological examination (NPE) answers three interrelated questions:
    • Is there objective evidence of impaired higher cerebral (or integrated) brain functions?
    • Do the pattern and level of the NPE findings suggest a diffuse, lateralized, or regionalized cerebral dysfunctions?
    • Are the pattern and level of disturbed functions compatible with a known and suspected brain disorder in a given patient?
  2. The VALUE of the NPE:
    • Reduces cost and liabilities by describing impairment of higher cerebral functioning
    • Improves quality of life by describing impairment in higher cerebral functioning
    • Determines the effectiveness of treatment and directs treatment procedures by assessing disturbances in higher cerebral functioning
    • Provides continuum of care
    • Improves physician education and decision making

NEUROPSYCHOLOGICAL CASE ANALYSIS WITH RECOMMEDNING AN NPE CAN RESULT IN THE FOLLOWING:

  1. Documentation of cognitive impairment
  2. Delineation of specific areas of cognitive deficits, differential diagnosis, estimation of functional statues and intervention planning
  3. Description of overall constellation of neuropsychological profile
  4. Documentation of the need for non-pharmacological interventions
  5. Determination of functional status to guide management decisions regarding limitations
  6. Intervention programs
  7. Individual medical adjustment counseling

NEUROPSYCHOLOGICAL CASE ANALYSIS FOR TRAUMTIC BRAIN INJURY/ POSTCONCUSSION SYNDROME:

  1. Documentation of cognitive, behavioral and emotional status
  2. Feedback to family members and to improve patient awareness
  3. Assess effectiveness of drug trials
  4. History taking to determine if period of posttraumatic amnesia existed
  5. Performance and symptom validity analysis
  6. Analysis of interactions between cognitive, physical and emotional disturbance and concluding whether or not a mild traumatic brain injury has occurred
  7. Determination of ability to function independently
  8. Decision making capacity
  9. Time limits of return to work, school, and social settings

NEUROPSYCHOLOGICAL CASE ANALYSIS IN SPORTS NEUROPSYCHOLOGY:

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Robert B. Sica, PhD, FACPN is a Neuropsychologist specializing in Clinical and Forensic Neuropsychology. Dr. Sica is a staff clinical neuropsychologist in the Neuroscience Division at Jersey Shore University Medical Center (JSUMC) and Riverview Medical Center, both members of the Meridian Health Care System, where he treats patients along with his academic responsibilities of teaching medical students, residents, and neuropsychological interns.

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