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Multidisciplinary Care for Pediatric Patients With Psychogenic Nonepileptic Seizures May Be Associated With Decreased
Sahana Rao1, Maggie Burch1, Megan M Fredwall1
1Ohio 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.
Insights
A specialized clinic significantly reduced healthcare use for youth with psychogenic nonepileptic seizures (PNES). This multidisciplinary approach lowered emergency visits and diagnostic tests, improving patient care and saving costs.
Area of Science:
- Neurology
- Psychiatry
- Health Services Research
Background:
- Psychogenic nonepileptic seizures (PNES) are events with psychological origins that mimic epileptic seizures.
- Patients diagnosed with PNES exhibit high rates of healthcare utilization.
- The effectiveness of specialized care in reducing healthcare utilization for PNES patients is under investigation.
Purpose of the Study:
- To evaluate the impact of a multidisciplinary PNES clinic on healthcare utilization (HCU) in pediatric patients.
- To assess changes in emergency department visits, hospitalizations, and diagnostic testing post-referral.
Main Methods:
- Retrospective chart review of 212 patients referred to a multidisciplinary PNES clinic between November 2017 and March 2020.
- Comparison of HCU metrics (ED visits, hospitalizations, neurodiagnostic studies) 12 months before and after clinic referral.
- Analysis of cost savings associated with reduced HCU.
Main Results:
- A 75% reduction in emergency department visits was observed post-referral (410 to 187 visits).
- All measured HCU metrics, including urgent care visits and hospitalizations, decreased significantly after attending the clinic.
- An estimated potential cost saving of $7,978,447 was identified, excluding head MRI costs.
Conclusions:
- Referral to a multidisciplinary PNES clinic leads to substantial reductions in healthcare utilization for youth with PNES.
- Specialized care effectively decreases emergency services use and unnecessary diagnostic procedures.
- This approach offers significant potential for cost savings in managing PNES.
Background And Objectives:
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.
Methods:
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.
Results:
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.
Discussion:
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.
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