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

Abstract

Background: Insufficient evidence exists to support the recommendation for coordinated, multidisciplinary care for the outpatient treatment of patients with anorexia nervosa. The objective of this study was to conduct a pragmatic assessment of care delivered through a retrospective comparative examination of patients who received a coordinated, multidisciplinary approach (medical provider, registered dietitian, and mental health professional collaborating to coordinate patient care) on clinical outcomes for treatment of anorexia nervosa (AN). Methods: Historical electronic medical record 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, body mass index percentile for pediatric patients) defined AN severity and weight restoration. Electronic medical record 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). Additionally, patients receiving care from 1-2 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. Conclusions: This retrospective chart review supports the coordinated, multidisciplinary care model for the outpatient treatment of AN.