PILOT Studies of Treatment Outcome Protocol

Introduction

Evaluation of the effectiveness of treatment of eating disorders has been hampered by lack of a standardized outcome protocol. The AED Credentialing Task Force* has recommended that residential and hospital treatment programs applying for Credentialing follow a standardized Outcome Measurement Assessment at admission, discharge, and one year follow-up. The pilot studies (from two residential treatment programs) are early efforts to delineate and utilize this standardized assessment.

* The AED Task Force representing the AED, National Eating Disorders Association, and the International Association of Eating Disorder Professionals began formulating criteria for accreditation of residential and hospital eating disorder treatment centers in response to family concerns that it was difficult to choose appropriate qualified effective treatment settings for their loved ones with eating disorders. In 2004, an international task force was formed including Mary Tantillo PhD, RN, CS (Chair), Ovidio Bermudez MD, Doug Bunnell PhD, Jillian Croll PhD, MPH, RD, Julie Holland MHS, CEDS, Craig Johnson, PhD, Jim Mitchell MD, Pauline Powers MD, Benita Quakenbush PhD, Mae Sokol MD, Janet Treasure FRCPPsych, Joel Jaharus MD, William Davis PhD and Consultants Marsha Marcus PhD, and Joel Yager MD. The Task Force has developed standards and this report on outcome assessment is one part of the planned standards. 

Methods

AED Credentialing Task Force:
Outcome Measurement Assessment

Required Outcome Measures	Recommended
Outcome Measures

General	Admission	Discharge	1 yr. F/U
History and Physical	+
DSM-IV-TR ED	+	+	+
Freq. BE/P	+	+	+
Ht/Weight	+	+	+
Instruments
EDI-3	+	+	+
BDI	+	+	+
SF-36	+	+	+
EDQOL	+	+	+
Treatment since Discharge			+
Satisfaction Questionnaire		+

Results (cont.)

In the first study at Fairwinds, patients were assessed at admission and discharge in terms of core symptoms. Among the AN patients who completed treatment, 81% achieved ideal body weight. Among patients who were binge eating at admission (which included ANBP patients, and all BN patients), 86% of treatment completers ceased this behavior for at least 14 days prior to discharge. Among patients who were purging at admission and completed treatment, 86% ceased this behavior at least 14 days prior to discharge. No patients were discharged prematurely for financial reasons; 117 (84%) patients completed treatment. In the second study at Avalon Hills, patients were assessed utilizing the four instruments recommended by the task force at admission, discharge, and follow-up between June 2007 and December 2008. At admission 64 patients (32 adolescents and 32 adults) completed the instrument package and 45 completed the instruments at discharge (40 were analyzable). From admission to discharge there were statistically significant improvements in key subscales of the EDI-3 (Drive for Thinness, Bulimia, and Body Dissatisfaction subscales). There was no significant deterioration in these subscales at follow-up (7 at 3 months, 5 at 6 months, and one at one year). Similarly there were statistically significant improvements in scores on the Beck Depression Inventory, SF-36, and Eating Disorder Quality of Life (ED QOL) instruments from admission to discharge.

Conclusions

Together these two pilot studies include the majority of the items in the Outcome Measurement Assessment required by the AED Task Force. Symptom assessment includes determination of change in core symptoms (weight, binge-eating, and purging) and the four instruments evaluate typical psychological symptoms and quality of life (both general and eating disorder specific) and the commonly seen co-morbid disorder of depression. The four instruments were sensitive to change and it is recommended that they continue to be used. At both treatment centers there was evidence of significant improvement from admission to discharge.