Original article
An Eleven Site National Quality Improvement Evaluation of Adolescent Medicine-Based Eating Disorder Programs: Predictors of Weight Outcomes at One Year and Risk Adjustment Analyses

https://doi.org/10.1016/j.jadohealth.2011.04.023Get rights and content

Abstract

Purpose

This quality improvement project collected and analyzed short-term weight gain data for patients with restrictive eating disorders (EDs) treated in outpatient adolescent medicine-based ED programs nationally.

Methods

Data on presentation and treatment of low-weight ED patients aged 9–21 years presenting in 2006 were retrospectively collected from 11 independent ED programs at intake and at 1-year follow-up. Low-weight was defined as < 90% median body weight (MBW) which is specific to age. Treatment components at each program were analyzed. Risk adjustment was performed for weight gain at 1 year for each site, accounting for clinical variables identified as significant in bivariate analyses.

Results

The sites contained 6–51 patients per site (total N = 267); the mean age was 14.1–17.1 years; duration of illness before intake was 5.7–18.6 months; % MBW at intake was 77.5–83.0; and % MBW at follow-up was 88.8–93.8. In general, 40%–63% of low weight ED subjects reached ≥90% MBW at 1-year follow-up. At intake, patients with higher % MBW (p = .0002) and shorter duration of illness (p = .01) were more likely to be ≥90% MBW at follow-up. Risk-adjusted odds ratios controlled for % MBW and duration of illness were .8 (.5, 1.4)–1.3 (.3, 3.8), with no significant differences among sites.

Conclusion

A total of 11 ED programs successfully compared quality improvement data. Shorter duration of illness before intake and higher % MBW predicted improved weight outcomes at 1 year. After adjusting for risk factors, program outcomes did not differ significantly. All adolescent medicine-based ED programs were effective in assisting patients to gain weight.

Section snippets

Methods

In March 2008, a total of 11 Adolescent Medicine Eating Disorder Programs across the United States started a comparison of basic information by performing a retrospective chart review of their patients who had low body weight and a restrictive ED, who presented between January 1, 2006, and December 31, 2006, had at least three follow-up appointments, and were followed up for ≥8 months. The follow-up visit that was closest to 1 year from the intake visit (between 8 and 15 months after intake)

Results

Data on 267 patients (254 females and 13 males) were collected from 11 sites, with the number of patients at each ranging from a minimum of six patients at site K to a maximum of 51 patients at site H. The mean number of patients per site was 24. Table 1 shows sites A through K displayed with the mean BMI of patients at intake and at follow-up, which is not age-adjusted. All sites were able to increase BMI over the year of follow-up, and the change was statistically significant. The mean

Discussion

The present study is the first national multisite comparison study assessing weight recuperation in patients with restrictive EDs treated at adolescent medicine-based programs. Our analyses indicated that all programs involved in this QI evaluation were similarly effective in improving the weight of their patients when risk adjustment was made for patient severity at presentation. The two factors which were found to be significant predictors of weight recovery were duration of symptoms at

Conclusion

This national collaborative is the first of its kind for assessing outcomes across multiple adolescent medicine-based ED programs. The findings were unable to show that there are significant differences between program outcomes, but do highlight the efficacy of all programs in facilitating recovery. The factor common to the programs is that they are adolescent medicine-centered. Adolescent medicine-based ED programs are able to successfully increase weight of outpatients with restrictive EDs

Acknowledgments

The authors thank the faculty, staff, and research assistants at all of the participating sites who made this national collaboration possible. They also thank Nicole McKenzie for her efforts in helping with the preparation of the manuscript.

The study was supported in part by LEAH number T71MC00009, LEAH number T71MC00011, MCHB, HRSA.

References (17)

There are more references available in the full text version of this article.

Cited by (39)

  • Bulimia nervosa

    2023, Encyclopedia of Child and Adolescent Health, First Edition
  • Anorexia nervosa

    2023, Encyclopedia of Child and Adolescent Health, First Edition
  • Medical Management of Restrictive Eating Disorders in Adolescents and Young Adults

    2022, Journal of Adolescent Health
    Citation Excerpt :

    AYAs with restrictive EDs often first present to medical providers, whose role in early identification and management is crucial. Timely intervention can result in shorter duration of illness with improved outcome [3]. Initial evaluation involves diagnosis; exclusion of other causes of weight loss or vomiting; nutritional and psychosocial assessment; determination of severity of malnutrition; and evaluation of medical complications and comorbidities.

View all citing articles on Scopus
View full text