@article{f1b9d01f46bd4bbba7795df40401a014,
title = "A path to defining excellence in intensive treatment for eating disorders",
abstract = "In the United States, the past decade has seen rapid growth in treatment centers providing specialty care to patients with eating disorders. Much of this growth has been in higher levels of care, including hospital-based and residential treatment. Despite this expansion, there remains lack of agreement regarding the most important components of care, such as staff training or specifics of treatment delivery. Additionally there is no consensus on how best to assess outcome and compare performance across programs. This leaves patients, families, public and private insurance programs, and policy makers with limited information to help facilitate treatment decisions. The present paper considers implications of these changes in the eating disorder treatment landscape and examines two ideas that, if implemented, may enhance the quality of eating disorder care. First, we explore the proposal to develop a network of centers of excellence in eating disorder treatment and the value this may have for improving overall treatment quality. This idea was discussed at an expert meeting held at SAMSHA in 2017 regarding issues important to the field following passage of the 21st Century Cures Act. Second, we consider the potential utility of a study using the Delphi method to promote expert consensus regarding clinical outcome assessments.",
keywords = "anorexia nervosa, center of excellence, eating disorders, inpatient, intensive treatment, outcome, residential treatment",
author = "Guarda, {Angela S.} and Stephen Wonderlich and Walter Kaye and Evelyn Attia",
note = "Funding Information: Clinical outcome measurement is a sine qua non for any best practice program, and variables such as short and longer term functional improvement, treatment costs, and patient/family experience may be some, but not all of the metrics for quality care. The Delphi process could help identify clinical measures and data collection methods supported by experts in the field and facilitate consensus on whether the establishment of COEs based on risk-adjusted outcomes is useful. Investigators could then guide experts through the Delphi process to define features of a comprehensive center of excellence in the care of eating disorders and the metrics for assessing the quality of care it provides. Oversight of this process could be provided by a federal agency, an advocacy organization, or by an alliance among academia, private programs, insurance companies and governmental agencies. Leadership input from state and federal agencies and health insurers could assist in sharing quality measurement information across organizations (Pincus, Scholle, Spaeth-Rublee, Hepner, & Brown, 2016). Financial support for a clinical data registry and data monitoring as a requirement of participation could come from member program fees, similar to the MBSAQIP or the National Network of Depression Centers (NNDC), with a differential fee structure depending on program size and type. For-profit programs are perhaps uniquely incentivized to consider providing collaborative financial support aimed at improving quality care through such a mechanism, thereby advancing research on care and treatment of patients with eating disorders. By providing a means to achieve consensus when firm data may be lacking, the Delphi method offers a potentially useful path to defining an eating disorder COE and/or a system of outcomes collection. Identifying useful metrics could assist programs in evaluating their performance against benchmark standards, refine COE definitions and inform future discussions of quality care. Funding Information: Healthcare COEs have been established by professional medical groups, government entities, mental health agencies, and insurance companies. Professional medical groups have established COEs to raise practice standards and to require outcome reporting (e.g., the American Society of Metabolic and Bariatric Surgery and the American College of Surgeons established the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)). Amongst government entities, the Substance Abuse and Mental Health Services Administration (SAMHSA), in partnership with Health Resources and Services Administration (HRSA) and Administration for Children and Families (ACF), established the Center of Excellence for Infant and Early Childhood Mental Health Consultation (SAMHSA, 2015), and the National Institutes of Health established autism centers of excellence (P50; RFA-HD-17–009). Finally, large insurance companies have partnered with preferred clinical centers to establish COEs (e.g., Aetna Institutes, United Health Group-Optum Centers of Excellence Programs). Publisher Copyright: {\textcopyright} 2018 Wiley Periodicals, Inc.",
year = "2018",
month = sep,
doi = "10.1002/eat.22899",
language = "English (US)",
volume = "51",
pages = "1051--1055",
journal = "International Journal of Eating Disorders",
issn = "0276-3478",
publisher = "John Wiley and Sons Inc.",
number = "9",
}