A Retrospective Chart Review Suggests That Coordinated, Multidisciplinary Treatment for Patients with Anorexia Nervosa Improves Odds of Weight Restoration

Abstract

Kary Woodruff,1 Elizabeth A Joy,2 Ryan D Burns,3 Scott A Summers,1,* Julie M Metos,1,* Kristine C Jordan1 1Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA; 2Office of Health Promotion and Wellness, Intermountain Health, Salt Lake City, UT, USA; 3Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA*These authors contributed equally to this workCorrespondence: Kary Woodruff, University of Utah, 250 South 1850 East, Room 210, Salt Lake City, UT, 84112, USA, Tel [phone], Email [email protected]: The objective of this study was to conduct a secondary data analysis of clinical information documented in the electronic medical record to assess the clinical outcomes of patients who received three different treatment approaches on clinical outcomes for treatment of patients with anorexia nervosa (AN).Patients and methods: Historical electronic medical record (EMR) data on patients aged 6 to 80 years diagnosed with AN seen in a healthcare system between 2007 and 2017 were stratified, according to services received, into three groups: Group A (n = 48) received hospital-based services; Group B (n = 290) saw one or two provider types; Group C (n = 26) received outpatient coordinated multidisciplinary care from three provider types. Clinical outcomes [body mass index for adults (BMI), body mass index percentile (BMI%ile) for pediatric patients] defined AN severity and weight restoration. EMR data were analyzed using a generalized mixed-effects model and a Markov Transition model to examine the odds of weight restoration and the change in odds of weight restoration across the number of provider visits, respectively.Results: Patients receiving coordinated multidisciplinary care had significantly higher odds of weight restoration compared with patients receiving hospital-based services only (OR = 3.76, 95% CI [1.04, 13.54], p = 0.042). In addition, patients receiving care from 1 to 2 providers (OR = 1.006, 95% CI [1.003, 1.010], p = 0.001) or receiving coordinated multidisciplinary care (OR = 1.005, 95% CI [1.001, 1.011], p = 0.021) had significantly higher odds of weight restoration per provider visit day compared with patients receiving hospital-based services only.Conclusion: This retrospective chart review supports the coordinated, multidisciplinary care model for the weight restoration in patients with AN in an outpatient setting.Plain Language Summary: Treatment recommendations for the care of individuals with anorexia nervosa recommend a coordinated, multidisciplinary approach that, at a minimum, includes the following healthcare professional groups: a medical provider, mental health professional, and registered dietitian. Until there is enough evidence for this treatment approach in outpatient settings, it will remain underutilized, compromising the treatment of patients with anorexia nervosa. Since it would be unethical to conduct a randomized trial comparing coordinated, multidisciplinary care with uncoordinated care (it has already been identified as “best practice” by the American Psychiatric Association), the current study conducted a pragmatic, retrospective analysis of this care model on restoring weight in patients with anorexia nervosa. Patients were grouped according to the services they received: hospital-based services only (Group A), treatment from one or two different healthcare professional types (Group B), or treatment provided by all three healthcare professional types representing coordinated care (Group C). The results suggest that patients in Group C were more likely to restore weight, a necessary criterion for eating disorder recovery, compared with the other two groups. We hope these results provide the necessary support for increased use of an important treatment approach for treating individuals with anorexia nervosa.Keywords: eating disorders, recovery, treatment team

Keywords

• eating disorders
• recovery
• treatment team