Objective: To investigate the impact of diagnosis on health care utilization (HCU) in the functional movement disorders (FMD) population.

Background: FMD patients are considered to be high health care utilizers, to an extent that has been described as a crisis.¹ Functional neurologic presentations may represent up to 30% of cases in neurology clinic.² Current expert opinion is that delivery of FMD diagnosis is a key part of the therapeutic process.³ There is a paucity of data on whether expert diagnosis of FMD affects health care utilization . We hypothesize that clear delivery of diagnosis by movement disorder specialists reduces health care utilization.

Method: This was a retrospective analysis of HCU in patients diagnosed with predominant FMD in the UCLA Movement Disorders clinics between January 2014 until December 2018. Cases were identified by ICD10 codes and validated by chart review using diagnostic criteria (adapted from Lang/Gupta).⁴ We included patients who were diagnosed with FMD (Dx) or FMD was high on a differential diagnoses (DDx) and who received follow-up at UCLA. We assessed frequency of outpatient, inpatient, emergency, imaging and procedure encounters as HCU measures for 12 months before and after diagnosis date.

Results: Of 42 patients with validated FMD Dx or DDx, 18 patients (14 female, mean age 51.6 [16-92 range]) received follow-up care and were analyzed. We found a significant decrease in imaging studies (mean 4.9 pre-dx, 2.8 post-dx, p=0.005) and no significant changes in outpatient visits (7.9 pre-dx, 10.0 post-dx, p=0.48); procedures (1.55 pre, 2.83 post, p=0.37); patient messages (10.6 pre, 11.2 post, p=0.87). There were very few emergency room (ER) and hospital encounters with no significant differences (combined 1.06 pre, 0.56 post, p=0.25). Among 13 patients who received advice about psychotherapy, we found a significant decrease in ER/hospital visits (1.08 pre, 0.15 post, p=0.046).

Conclusion: Results suggest that a clear FMD diagnosis or presentation of FMD as a viable differential diagnosis in a tertiary movement disorders clinic may reduce imaging utilization. Further, recommendations for psychotherapy may contribute to reduction of hospital and ER utilization. This study is limited by small sample size at a single institution, by excluding patients who did not follow-up at our institution and by information available only from our institutional electronic health record.

References: 1. Hallett, M. Psychogenic movement disorders: A crisis for neurology. Curr. Neurol. Neurosci. Rep. 6, 269–271 (2006). 2. Evens, A., Vendetta, L., Krebs, K. & Herath, P. Medically Unexplained Neurologic Symptoms: A Primer for Physicians Who Make the Initial Encounter. Am. J. Med. 128, 1059–1064 (2015). 3. Stone, J., Carson, A. & Hallett, M. Explanation as treatment for functional neurologic disorders. in Handbook of Clinical Neurology (2016). doi:10.1016/B978-0-12-801772-2.00044-8 4. Gupta, A. & Lang, A. E. Psychogenic movement disorders. Curr. Opin. Neurol. 22, 430–6 (2009).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/an-analysis-of-health-care-utilization-in-functional-movement-disorders-does-diagnosis-make-a-difference/