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

Abstract

Purpose

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

Ethics Approval and Consent to Participate

The Intermountain Healthcare Institutional Review Board (IRB) approved the study. Given that the study qualified for exempt status due to the retrospective chart review format, participant consent was not required.

Data Protection and Privacy

The data referenced in this study complied with relevant data protection and privacy regulations.

Acknowledgments

The primary investigator of this study would like to acknowledge the contributions of Andrew Wilson, PhD, for his statistical guidance, and Phil Johnson and Kenneth Pena, Senior Statistical Data Analysts at Intermountain Health. This research study has not received any funding.

Disclosure

The authors report no conflicts of interest in this work. No financial arrangements, organizational affiliations, or relationships constitute a conflict of interest regarding the manuscript’s content.

Additional information

Funding

There was no funding for the research.