2021 MBHR Measure: Patient Feedback of Test Results Following Cognitive or Mental Status Assessment

QCDR Name: MBHR Mental and Behavioral Health Registry

Measure Justification

Practice guidelines from the American Academy of Clinical Neuropsychology (AACN) assert the importance and value of providing feedback directly to a patient or their caregiver at the completion of standardized cognitive testing in order to help patients understand their condition and provide recommendations [1]. Furthermore, principles from the American Psychological Association states psychologists must take “reasonable steps to ensure that explanations of results are given to the individual or designated representative unless the nature of the relationship precludes provision of an explanation of results” [2]. Reference books and applicable research document patients’ perceived value from feedback sessions that clearly describe the meaning of cognitive test results and their applications to everyday life [3, 4].

1. Neuropsychology, A.A.o.C., American Academy of Clinical Neuropsychology (AACN) practice guidelines for neuropsychological assessment and consultation. Clin Neuropsychol, 2007. 21(2): p. 209-31.
2. Psychological, A. and Association, Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). 2017.
3. Postal, K. and K. Armstrong, Feedback that sticks: The art of effectively communicating neuropsychological assessment results. 2013, New York, NY: Oxford University Press.
4. Postal, K., et al., The stakeholders’ project in neuropsychological report writing: a survey of neuropsychologists’ and referral sources’ views of neuropsychological reports. Clin Neuropsychol, 2018. 32(3): p. 326-344.

Cognitive and mental status assessments result in valuable information to assist with diagnostic determination, treatment planning, and determination of prognosis [5]. These evaluations often identify the presence of cognitive impairment that may have significant impact on an individual’s life, including interpersonal relationships, work function and future independence. When providing feedback of assessment results, the goal is to provide patients with a better understanding of their medical condition and prognosis, to improve their participation in treatment planning and to assist them with making necessary lifestyle adjustments to improve ultimate health outcomes [6-8].

Assessments of cognitive functioning are typically accomplished by providers performing a consultative role or to assist treatment planning in some manner. Thus, such evaluations typically occur over one encounter and do not involve ongoing care. By way of example, neuropsychological evaluations are the pinnacle of cognitive assessments and include a clinical interview in conjunction with administration of standardized tests of cognitive, emotional, and personality functioning. Evaluations are structured according to medical needs, specific referral questions, and patient characteristics [1]. Although evaluations may, by virtue of necessity, be accomplished over several patient visits, many evaluations are completed in one patient visit. Further, when multiple visits occur, these visits combined are considered one episode of care. Although many neuropsychologists provide treatment, neuropsychological evaluations are most often consultative in nature. Thus, for most neuropsychological evaluations, care is not ongoing and there may only be one patient encounter (or one episode of care) with test results and recommendations provided directly to the referral source and patient and their caregiver. For description of practice patterns in neuropsychology see [1, 9].

A customary, but not required, part of the neuropsychological evaluation is to communicate results and recommendations through a post-evaluation feedback session(s) with the patient and family members [1]. Depending on the clinical setting and other factors, this information may be communicated to the referring provider or treatment team, who then integrates the information into the treatment plan and communicates directly with the patient or caregiver. Communication of assessment results has been shown to be highly valued by patients [3, 8, 10] and physicians who refer their patients for neuropsychological assessments [4, 11] and psychological assessment results been empirically shown to produce clinically meaningful benefits [12] including symptomatic improvements [13]. Further, those receiving feedback of cognitive test results were more inclined to have followed patient safety recommendations [10]. Neuropsychology, A.A.o.C., American Academy of Clinical Neuropsychology (AACN) practice guidelines for neuropsychological assessment and consultation.

1. Clin Neuropsychol, 2007. 21(2): p. 209-31.
2. Psychological, A. and Association, Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). 2017.
3. Postal, K. and K. Armstrong, Feedback that sticks: The art of effectively communicating neuropsychological assessment results. 2013, New York, NY: Oxford University Press.
4. Postal, K., et al., The stakeholders’ project in neuropsychological report writing: a survey of neuropsychologists’ and referral sources’ views of neuropsychological reports. Clin Neuropsychol, 2018. 32(3): p. 326-344.
5. Watt, S. and S.F. Crowe, Examining the beneficial effect of neuropsychological assessment on adult patient outcomes: a systematic review. Clin Neuropsychol, 2018. 32(3): p. 368-390.
6. Rosado, D.L., et al., Neuropsychological feedback services improve quality of life and social adjustment. Clin Neuropsychol, 2018. 32(3): p. 422-435.
7. Doyle, C., L. Lennox, and D. Bell, A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open, 2013. 3(1).
8. Manary, M.P., et al., The patient experience and health outcomes. N Engl J Med, 2013. 368(3): p. 201-3.
9. Sweet, J.J., et al., The TCN/AACN 2010 “salary survey”: professional practices, beliefs, and incomes of U.S. neuropsychologists. Clin Neuropsychol, 2011. 25(1): p. 12-61.
10. Westervelt, H.J., et al., Patient and family perceptions of the neuropsychological evaluation: how are we doing? Clin Neuropsychol, 2007. 21(2): p. 263-73.
11. Zolnierek, K.B. and M.R. Dimatteo, Physician communication and patient adherence to treatment: a meta-analysis. Med Care, 2009. 47(8): p. 826-34.
12. Poston, J.M. and W.E. Hanson, Meta-analysis of psychological assessment as a therapeutic intervention. Psychol Assess, 2010. 22(2): p. 203-12.
13. Miller, L.R., A. Cano, and L.H. Wurm, A motivational therapeutic assessment improves pain, mood, and relationship satisfaction in couples with chronic pain. J Pain, 2013. 14(5): p. 525-37.