Rao Sahana, Burch Maggie, Fredwall Megan M, Enciso Laurie, Trott Kristen, Patel Anup D, Albert Dara V F
Ohio University Heritage College of Osteopathic Medicine (SR), Athens; Division of Neurology (MB, MMF, LE, ADP, DVFA), Department of Pediatrics, Nationwide Children's Hospital/The Ohio State University; Division of Pediatrics and Neuropsychology (KT); and The Center for Clinical Excellence (ADP), Nationwide Children's Hospital, Columbus, OH.
Neurol Clin Pract. 2023 Dec;13(6):1-6. doi: 10.1212/CPJ.0000000000200195. Epub 2023 Oct 2.
Psychogenic nonepileptic seizures (PNES) are paroxysmal events that resemble epileptic seizures but have psychological underpinnings. Patients with PNES have high health care utilization. We hypothesize that appropriate care would lead to decreases in utilization. The aim of this study was to measure the impact of a multidisciplinary PNES clinic in reducing health care utilization (HCU) in youth with PNES referred to the clinic.
We reviewed the frequency of visits to the emergency department (ED), urgent care (UC), planned and unplanned hospitalizations, neurodiagnostic studies, and total charges associated with these encounters 12 months before and 12 months after initial referral to the clinic. Manual chart review of all patients referred from November 2017 to March 2020 was performed.
Two hundred and twelve unique patients were included in this retrospective study. Patient sex was identified as 71% female, 28% male, and 1% other, with an average age of 14 years at diagnosis. These patients visited the ED a total of 410 times before being seen in the PNES clinic, which decreased to 187 visits after (75% reduction). All measures of HCU decreased in the 12 months after the visit, and statistically significant differences were observed in all measures of HCU except for head MRIs, leading to an estimated potential cost savings of $7,978,447.
Patients with PNES were found to have decreased health care utilization in the 12 months after referral to the Nationwide Children's Hospital multidisciplinary clinic, including significant decreases in emergency services and unnecessary diagnostic testing, in the 12 months after the referral.
心因性非癫痫性发作（PNES）是一种类似于癫痫发作但有心理基础的阵发性事件。PNES患者的医疗保健利用率很高。我们假设适当的护理会导致利用率下降。本研究的目的是衡量多学科PNES诊所对转诊至该诊所的青少年PNES患者降低医疗保健利用率（HCU）的影响。
我们回顾了初次转诊至诊所前12个月和转诊后12个月患者到急诊科（ED）就诊的频率、紧急护理（UC）、计划内和计划外住院、神经诊断检查以及与这些诊疗相关的总费用。对2017年11月至2020年3月转诊的所有患者进行了人工病历审查。
这项回顾性研究纳入了212名独特的患者。患者性别为71%女性、28%男性、1%其他，诊断时的平均年龄为14岁。这些患者在PNES诊所就诊前共到急诊科就诊410次，就诊后降至187次（减少75%）。就诊后12个月内，所有HCU指标均下降，除头部MRI外，所有HCU指标均观察到统计学显著差异，估计潜在成本节约7978447美元。
研究发现，转诊至全国儿童医院多学科诊所后的12个月内，PNES患者的医疗保健利用率下降，包括转诊后12个月内急诊服务和不必要诊断检查的显著减少。
