Academic journal article Journal of Eating Disorders

The Short Treatment Allocation Tool for Eating Disorders: Current Practices in Assigning Patients to Level of Care

Academic journal article Journal of Eating Disorders

The Short Treatment Allocation Tool for Eating Disorders: Current Practices in Assigning Patients to Level of Care

Article excerpt

Author(s): Josie Geller[sup.1,2], Leanna Isserlin[sup.3], Emily Seale[sup.3], Megumi M. Iyar[sup.1,4], Jennifer S. Coelho[sup.2,5], Suja Srikameswaran[sup.1,2] and Mark Norris[sup.6]

Plain English summary

The Short Treatment Allocation Tool for Eating Disorders (STATED) is a new tool developed to help match patients to the most appropriate and cost-effective care (Geller et al., 2016). The objective of this research was to determine if current practices are in alignment with STATED recommendations. Healthcare professionals providing care for youth and/or adults with eating disorders completed an online survey and rated the extent to which they used the STATED guidelines to assign patients to the appropriate level of care. It was determined that although practices were generally aligned with the STATED recommendations, there were some inconsistencies, with information about readiness for change being used least reliably in assigning patients to level of care.

Background

Eating disorders (EDs) are often chronic conditions characterized by treatment refusal, premature termination, and relapse across all levels of care resulting in significant health care costs [1]. There is little consensus regarding which patient characteristics are most helpful in assigning patients to the most appropriate level of care. For instance, although there is general agreement that hospitalization is indicated for a medically unstable patient, there is little consensus about how other patient factors should inform assignment to treatment, such as outpatient, day, or residential care. Despite a robust literature showing that readiness and motivation to recover is one of the strongest predictors of clinical outcome [2], this evidence is not systematically included in current decision-making models [3].

The Short Treatment Allocation Tool for Eating Disorders (STATED) is a simple innovative evidence-based algorithm that uses three patient dimensions; medical stability, symptom severity/life interference, and readiness/engagement in assigning level of care for individuals with EDs [3]. The STATED is unique in its inclusion of readiness information and in its allowance of independent variations along the three continua. Readiness refers to an individual's internal motivation to engage in symptom reduction goals of action-oriented treatment. The STATED was developed in the context of the Canadian health care system where there are five levels of publically funded resources: two lesser resource outpatient options, two higher resource options involving a combination of outpatient residential and inpatient settings and finally, inpatient hospital admission (see Table 1). These levels of care are similar to those outlined in the American Psychiatric Association [4] guidelines, with the exception that only the STATED includes a treatment option that focuses on quality of life, recommended and shown to be effective for individuals whose readiness is low and whose symptom severity is high [5, 6].

Allocation of Patients According to the STATED Dimensions (%)

The STATED was developed with the intent to promote best resource utilization in its use of empirical evidence in matching patients to treatment [3]. In its inclusion of readiness as a central component, the STATED is supported by two decades of research showing the key role that readiness plays in predicting symptom improvement, dropout and relapse in this population [7-10]. The development of the STATED came about in response to previous protocols either failing to take into account patient readiness for treatment and/or assumptions about patients (i.e., high readiness co-occurs with low symptom severity) that don't reflect real-world, clinical experience.

The STATED is trans-diagnostic and represents all patient presentations across the developmental spectrum. Figure 1 depicts how patient information is used to assign patients to level of care. As shown, medical stability, defined as a patient's immediate medical risk ("yes" indicates low risk, "no" indicates risk, or medical instability), is the only information needed to determine whether a patient requires a hospital admission. …

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