title: [Formula: see text]inadequate effort on neuropsychological evaluation is associated with increased healthcare utilization.
abstract: Patients who exert inadequate effort on neuropsychological examination might not receive accurate diagnoses and recommendations, and might not cooperate fully with other aspects of healthcare. This study examined whether inadequate effort is associated with increased healthcare utilization. Of 355 patients seen for routine, clinical neuropsychological examination at a VA Medical Center, 283 (79.7%) showed adequate effort and 72 (20.3%) showed inadequate effort, as determined at time of evaluation using the Word Memory Test and/or Test of Memory Malingering. Utilization data included number of Emergency Department (ED) visits and inpatient hospitalizations in the year following evaluation. Patients who had shown inadequate effort on examination had more Emergency Department visits, more inpatient hospitalizations, and more days of inpatient hospitalization in the year after evaluation, compared to patients who had exerted adequate effort. This finding was not attributable to group differences in age or medical/psychiatric comorbidities. Thus, patients who exerted inadequate effort showed greater healthcare utilization in the year following evaluation. Such patients might use more resources since diagnostic evaluations are inconclusive. Inadequate effort on examination might also serve as a "marker" for more general failure to cooperate fully in one's healthcare, possibly resulting in greater utilization.
authors.affiliation: a Mental Health Service, Ralph H. Johnson Department of Veterans Affairs Medical Center , Charleston , SC , USA.
authors.forename: Michael David
authors.initials: MD
authors.lastname: Horner
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: VanKirk
authors.forename: Clara E
authors.initials: CE
authors.lastname: Dismuke
authors.forename: Travis H
authors.initials: TH
authors.lastname: Turner
authors.forename: Wendy
authors.initials: W
authors.lastname: Muzzy
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000592:standards / Q000706:statistics & numerical data*; D010045:Outpatients / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States
keywords: Clinical neuropsychology; Effort.; Health care utilization; Health outcomes; Neuropsychological assessment