Adapting a stepped-care model to outpatient neuropsychology in a Veterans Affairs hospital

Objective: Evaluate an outpatient neuropsychology stepped-care model to improve healthcare quality and efficiency. Compare utilization patterns and quality outcomes between brief neuropsychology evaluations (referred to as screening visit; [SV]) and comprehensive neuropsychological evaluations (CNEs) in a retrospective sample of Veterans. Methods: Consults (n = 139) were triaged based on chart review and evaluation of who may benefit from SV over CNE (e.g. active/undertreated mental health symptoms, substance use, recent CNE). All patients offered SV were also offered CNE. Referral questions were answered for both SV and CNE. Results: When offered the choice between SV and CNE, all patients selected SV. Active/under-treated mental health concerns were the most common reason for SV. Most SV visits did not require further neuropsychological testing (n = 25/36 or 69.44%). SVs facilitated faster access to care, with shorter time to feedback (SV mean days = 1.56, CNE mean days = 12.04) and an almost 20% faster time to see patients overall. Similar recommendations were provided for both SV and CNE, with mental health referrals as the most frequently cited. Utilizing SVs resulted in time and money savings and with 20% faster time to scheduling. Conclusions: The application of a neuropsychology stepped-care approach using SVs at our local facility demonstrated several positive outcomes, including improved efficiency and increased access to care.