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Program Outcomes

At Oliver-Pyatt Centers we believe the effectiveness of a program should not only be measured by how helpful and satisfied clients report their experience to be, but also by measurable and meaningful changes in clinical symptomatology and weight. To that point, we conducted a study that demonstrated statistically significant weight gain in our patients with Anorexia Nervosa treated in our residential level of care (LOC), with over 90% of them achieving weight restoration by discharge, defined by a body mass index (BMI) greater than 18.0.

While weight restoration is an essential measure of treatment outcome, effective treatments must also address the core psychological and behavioral symptoms of eating disorders and the impact they have on our patients’ lives. We conducted another study that examined symptom change in a subset of patients who participated in our residential and / or partial hospitalization program LOC. Importantly, this sample included patients with a diagnosis of Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder and other / unspecified eating disorder. Our data analysis revealed clinically and statistically significant symptom reduction (depression and eating disorder symptoms) and improved quality of life from admission to discharge.

In addition to sharing these preliminary findings below, we also discuss the state-of-the-art research program we are in the process of developing.

2016 Oliver-Pyatt Centers Research Findings

Weight Changes for Patients with Anorexia Nervosa

Methods and Sample
We examined weight change data for all our female patients diagnosed with Anorexia Nervosa (AN), according to DSM-5 criteria, who admitted to and discharged from residential treatment at Oliver-Pyatt Centers in 2016. This study included data for 56 residential stays (four of which were for patients who completed a second residential stay in 2016). Average length of stay in residential was 56 days.

Findings
Overall, results demonstrate weight gain in our patients with AN who participate in our residential LOC, with a high percentage of them achieving weight restoration.

  • 3% of adults in this study were admitted with a diagnosis of AN, Extreme (BMI < 15) and 12.5% admitted with a diagnosis of AN, Severe (BMI 15-15.99). Severity ratings are based on the DSM-5 criteria.
  • The average BMI of female adult patients with AN admitting to residential care at Oliver-Pyatt Centers was 17.8. The average BMI at discharge was 20.0.
  • Over 90% of our adult female patients with AN restored their weight to a BMI ≥ 18 by the time of discharge from our residential LOC.
  • As expected, results demonstrate a statistically significant increase in BMI for our patients from admission to discharge, t(55) = -8.947, p = 0.000. On average, patients experienced a BMI increase of 2.14 in residential care.

Symptom Change Data for a Subset of Patients

Methods and Sample
We collected symptom change data for a subset of our patients who admitted to and discharged from our comprehensive program at Oliver-Pyatt Centers in 2016. Specifically, we assessed symptoms of depression (Patient Health Questionnaire – 9), eating disorder symptoms (Eating Disorder Examination – Questionnaire) and quality of life (Eating Disorder Quality of Life Scale) upon admission and discharge.

Our comprehensive program provides residential and / or partial hospitalization program (PHP) LOC. 69% of all the patients treated in the comprehensive program in 2016 successfully completed the study (N = 88). The majority of that sample (69.3%) completed the continuum of care at comprehensive with both residential and PHP stays. Therefore, the symptom change data presented at this time largely represents a “full” comprehensive stay. Average length of stay in residential LOC was 54 days, average length of stay in PHP LOC was 41.5 days and total average length of stay in comprehensive was 80.74 days.

This sample included patients with the following ED diagnoses: 28% AN-Restrictive, 15% AN-Binge / Purge, 50% Bulimia Nervosa and 7% Binge Eating Disorder, Other or Unspecified. Importantly, this group of patients also presented with multiple co-morbidities: 100% were diagnosed with an anxiety disorder, 89% were diagnosed with a mood disorder, 37% were diagnosed with a substance use disorder, 13% were diagnosed with a personality disorder and 10% were diagnosed with post-traumatic stress disorder.

Findings
Overall, results show clinically and statistically significant symptom reduction (depression and eating disorder symptoms) and improved quality of life from admission to discharge.

Depression

  • Patients experienced clinically significant reductions in depression. On average, depression scores on the Patient Health Questionnaire-9 (PHQ-9) indicated “moderate” to “moderately severe” depression at admission and “no depression” at discharge.

  • Results also demonstrated statistically significant reductions in depression from admission to discharge, t(87) = 15.46, p = 0.000.

Eating Disorder Symptoms  

  • Patients experienced clinically significant reductions in eating disorder symptoms over the course of treatment. On average, patients presented at admission with severe eating disorder symptoms relative to community norms on the Eating Disorder Examination Questionnaire (EDE-Q)*. Upon discharge, average patient scores on the EDE-Q were consistent with community norms, suggesting clinically significant improvements. The chart below provides mean admission and discharge scores at OPC in comparison with community norms.

*Assessment of Eating Disorders: Interview or Self-Report Questionnaire? Fairburn, C. G., & Beglin, S. J. (1994). International Journal of Eating Disorders, 16, 363-370.

  • Results also demonstrated statistically significant reductions on the global scale as well as all subscales of the EDE-Q.
    • Global Score: t(87) = 17.7, p = 0.000.
      • Combines the subscales below.
    • Restraint: t(87) = 16.2, p = 0.000.
      • This subscale captures the following symptoms: restraint over eating; avoidance of eating; food avoidance; wanting an empty stomach; following strict dietary rules.
    • Eating Concern: t(87) = 14.6, p = 0.000.
      • This subscale captures the following symptoms: preoccupation with food, eating or calories; fear of losing control of eating; eating in secret; guilt about eating.
    • Shape Concern: t(87) = 11.8, p = 0.000.
      • This subscale captures the following symptoms: desire for a flat stomach; preoccupation with shape or weight; importance of shape; fear of weight gain; shape dissatisfaction; discomfort seeing body; feeling fatness; avoidance of body.
    • Weight Concern: t(87) = 11.3, p = 0.000.
      • This subscale captures the following symptoms: desire to lose weight; importance of weight; reaction to weight; preoccupation with shape and weight; dissatisfaction with weight.

Eating Disorder Quality of Life

  • Results demonstrated statistically significant improvements in psychological, physical / cognitive and work / school quality of life.

  • Psychological: t(87) = 14.72, p = 0.000.
    • This domain assesses how the eating disorder is perceived to have impacted thoughts and feelings about oneself.
  • Physical / Cognitive: t(87) = 12.19, p= 0.000.
    • This domain assesses how the eating disorder is perceived to have impacted physical sensations and cognitive capacity.
  • Work / School: t(87) = 3.85, p = 0.000.
    • This domain assess how the eating disorder is perceived to have impacted performance at school or work.

*It is preferable to measure quality of life once a client has fully discharged from residential and / or PHP care and is engaged in life outside of treatment. Our new research program (see Future Directions) will allow us to obtain this important post-discharge data.

Future Directions

We are pleased to share these preliminary findings with you. At Oliver-Pyatt Centers, we believe demonstrating the effectiveness of our programs is of utmost importance. These findings are an important step toward this goal and speak to the quality of care we provide.

That said, we hold ourselves to the highest scientific standards and acknowledge the limitations of these preliminary studies. Therefore, we are actively in the process of developing a state-of-the-art research program that will track client progress throughout treatment and up to one year follow up post-discharge. The research protocols have been approved by an Institutional Review Board. We have assembled a Monte Nido & Affiliates Research Committee of both in house and outside consultant researchers with extensive experience in the eating disorder field who are actively working to implement our new program. We are incredibly excited about this program, which is scheduled to launch in 2017.