Development and Validation of a Decision Tool for Early Identification of Adult Patients with Severe and Complex Eating Disorder Psychopathology in Need of Highly Specialized Care

Abstract

Patients with complex and severe eating disorders often receive a number of ineffective or/and insufficient treatments. Direct referral of these patients to highly specialized tertiary treatment facilities in an earlier stage of the disorder is likely to be more (cost)-effective. The aim of the study was to develop a decision tool that aids clinicians in early identification of these patients. After identification of criteria that were indicative of severity and complexity of eating disorder psychopathology by means of a systematic review of literature and consultation of a focus group, a Delphi method was applied to obtain consensus from experts on the list of relevant criteria. Finally, the decision tool was validated in clinical practice, and cut-off criteria were established. The tool demonstrated good feasibility and validity to identify patients for highly specialized tertiary care. The final decision tool consisted of five criteria that can easily be implemented in clinical practice. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

A path to defining excellence in intensive treatment for eating disorders

“…Furthermore, a broad base panel of experts may help inform a model of clinical excellence with international relevance and utility. The Delphi process has previously been used to answer targeted questions in the eating disorders field, including developing consensus around treatment for unhealthy exercise behaviors in adolescents with eating disorders (Noetel, Dawson, Hay, & Touyz, 2017), identifying criteria for the classification of severe and complex eating disorders (Dingemans et al, 2017), and identifying best nutritional counseling practices for anorexia nervosa (Mittnacht & Bulik, 2015).…”

Development and psychometric evaluation of the Transdiagnostic Decision Tool: matched care for patients with a mental disorder in need of highly specialised care

“…22,23 Given the level of necessary staff expertise, assessment and resources, highly specialised mental healthcare is often, but not per definition, provided in mental healthcare centres affiliated with academic medical settings. 22 In order to enhance the early identification and adequate management of patients with mental health problems in need of highly specialised care, the following four diagnosis-specific decision support algorithms were developed: the Decision Tool Personality Disorders, 19 the Decision Tool Eating Disorders, 18 the Decision Tool Unipolar Depression 20 and the Decision Tool Anxiety Disorders. 21 Building on the theoretical foundations of, and insights from, the development and psychometric evaluation of these diagnosis-specific decision tools, the Transdiagnostic Decision Tool was developed for use in heterogeneous patient groups, in patients with a diagnosis for which no diagnosis-specific decision tool is available and in patients without a clear primary diagnosis.…”

“…16,17 Recent initiatives to inform treatment decisions by pre-treatment patient characteristics include the development of diagnosis-specific decision tools for the following diagnostic groups: personality disorders, eating disorders, unipolar depression and anxiety disorders. [18][19][20][21] Decision tools are brief, clinician-administered instruments, especially designed to identify patients in need of highly specialised care during the diagnostic phase. Decision tools items include pre-treatment patient characteristics such as the absence or presence of psychiatric or somatic comorbidity, and the total score is an indicator of the need for highly specialised care.…”

“…Decision tools items include pre-treatment patient characteristics such as the absence or presence of psychiatric or somatic comorbidity, and the total score is an indicator of the need for highly specialised care. These diagnosis-specific decision tools have demonstrated solid psychometric properties, [18][19][20][21] and are used in psychiatric specialised centres to enhance the early identification of patients with a highly specialised mental healthcare need.…”