A - 68 Brain Health Clinic': a Neuropsychometric Screening & Triage Model.

OBJECTIVE: Cognitive symptoms are frequently not diagnostic for underlying brain damage or disease, but secondary to other treatable medical/psychiatric factors. Neuropsychological evaluation can inform the differential, but is limited by access issues and reduced diagnostic certitude in the setting of unmanaged secondary factors. Development and implementation of a neuropsychometric screening and triage model to address these issues has flexible application across different clinical settings.

DATA SELECTION: Literature on cognitive/behavioral/somatic screening methods were reviewed. Measures and associated cut-offs were selected based on open-source availability, clinical domain/condition relevance, intended population, and time to administer/interpret. Consultation with first-line clinicians in general neurology and non-neurology clinics guided refinement. Consultation with Neurologists informed triage guidelines. Recent CPT/CMS guidance on e-consultation billing was reviewed and integrated.

DATA SYNTHESIS: A "Brain Health Clinic" model composed of neuropsychometric screening with empirically-derived cut-off scores, along with expert consensus first-line intervention and triage, was piloted with advanced practice providers in a Cognitive Neurology Clinic. E-consultation support was provided by Neuropsychology. Practice findings and refinements are discussed. Adaptations to the model designed for a post-COVID clinic, Concierge Medicine clinic, and Primary Care Practice with integrated Neuropsychologist are reviewed.

CONCLUSIONS: Upstream extension of neuropsychological expertise via screening and triage with appropriate remote involvement of the neuropsychologist has the potential to resolve cognitive complaints prior to referral, or, optimization of confounding medical/psychiatric factors in those patients eventually escalated for full evaluation. New CPT/CMS billing options make this a viable approach for neuropsychologists across different clinical settings. Empirically-based refinement and assessment of outcomes in the future is indicated.