Eating Disorders & Mental Health: The Importance of Patient Outcomes
Why they matter and how they inform clinical care
From the time a patient is admitted — to when they “step down” to a lower level of care or discharge — Eating Recovery Center and Pathlight Mood & Anxiety Center (ERC Pathlight) uses scientifically accepted assessment tools to measure progress and the overall impact of treatment.
While this process is a standard best practice for all ERC Pathlight programs, it sets the treatment center apart as a leader in collecting and interpreting data on patient outcomes. Below are some frequently asked questions about outcomes-based research. The ERC Pathlight research team responds, sharing insights about the importance of this process.
1. What tools does ERC Pathlight use to collect information?
ERC Pathlight uses different tools to collect data. For eating disorders, the Eating Disorder Examination Questionnaire (EDE-Q) Global Score looks at general eating disorder thoughts and behaviors, as well as accompanying subscales. The subscales measure attempts to restrict food, along with concerns about eating, weight and shape. ERC Pathlight also uses the Patient Health Questionnaire-9 (PHQ-9) to measure depression and the General Anxiety Disorder-7 (GAD-7) assessment tool to measure anxiety for both patients with eating disorders and those with mood and anxiety disorders.
Renee D. Rienecke, PhD, FAED (she/her/hers), director of research at ERC Pathlight, notes that children and adolescents receive different questionnaires than adults. Because of ERC Pathlight’s emphasis on family involvement in treatment, parents of children and adolescents also complete questionnaires measuring constructs such as family functioning and expressed emotion, which has been shown to play an important role in treatment for children and adolescents.
2. How are the data interpreted?
The data collected at ERC Pathlight are viewed through two lenses—changes in symptoms from admission to discharge and effect size—an additional layer not usually addressed by treatment centers. Effect size goes beyond statistical significance and measures the practical implications of an outcome.
Craig Johnson, PhD, CEDS, FAED (he/him/his), senior clinical advisor at ERC Pathlight, explains that, in general, “larger effect sizes mean that patients, on average, made clinically significant progress toward recovery.” ERC Pathlight has another advantage in its data collection process: a large volume of patients across the nation with an 80-90% questionnaire response rate. Howard Weeks, MD, MBA, DFAPA, DFAACAP (he/him/his), chief medical officer at ERC Pathlight, notes that this high quantity of patient data means that the information is more statistically sound.
3. How is the information used?
The data are collected primarily to inform clinical care. In addition, the data can be used retrospectively for clinical quality research. To use the data, all research studies follow the rules set by the Institutional Review Board, which is designed to protect patients’ rights. “In effect, the research data are separated from the clinical data and stripped of identifying information to protect patient privacy, the standard used for all research projects,” says Dr. Weeks. “By standardizing the collection of outcomes data, we are able to produce a large database that allows us to explore associations and causations in clinical treatment.”
A new capability has recently been added to ERC Pathlight’s computer system: Data from the questionnaires can flow directly to a patient’s chart, providing “real-time information that can be used to develop treatment plans,” says Dr. Johnson. He adds that a data stream from an app called Recovery Record is providing even more information. “Patients can use the app to record their eating habits, exercise regimens and overall feelings about recovery while they’re in treatment and when they go home,” he explains. “This tool allows clinicians to stay in touch with their patients after discharge and has tremendous research potential.”
4. Has there been information from outcomes data that has affected treatment protocols for patients?
Yes. For example, “Our data showed that over half of our adult patients have PTSD symptoms at admission, with significant improvement over the course of treatment,” says Dr. Rienecke. “We already carefully screen for trauma at admission, but this finding may guide other similar treatment programs to screen for trauma and incorporate trauma-informed care into their treatment.”
Another change made based on data is the extension of the partial hospitalization eating disorder treatment program, referred to as PHP, from five days a week to seven. “Clinicians had known that patients often lost weight over the weekend in five-day-a-week programs,” says Dr. Weeks. “ERC designed our program to be seven days a week to prevent that regression and to improve outcomes.” What’s more, the data and subsequent articles published objectively demonstrated improved outcomes for our patients. Over time, a seven-day-a-week PHP was adopted as a standard of care in eating disorder treatment programs and is supported by insurance companies because they see the positive outcomes.
5. What challenges do you continue to face in collecting outcomes data?
Collecting data is hard, and it is a significant time commitment for the patient, family and treatment team. But the investment is well worth it. “Outcomes data is how we can show objectively and transparently that the treatment is working, and patients are getting better,” says Dr. Weeks. Dr. Johnson agrees, adding, “Our goal continues to be to challenge ourselves to improve how we collect information so that we can track whether our outcomes are improving.”
Dr. Weeks concludes, “We are constantly striving to find more efficient and better ways to make the data useful to patients and clinical teams so that everyone recognizes the value in collecting this information.”
Treatment that works: Positive Outcomes from ERC Pathlight
The charts below outline truly compelling positive outcomes across ERC Pathlight’s treatment of eating disorders, depression and anxiety among adults, children and adolescents. At ERC (Charts A and B), scores from the EDE-Q questionnaire showed significant improvement on all measures from admission to discharge for both populations, as was the case with measures of depression and anxiety. Similarly, the Pathlight results from the PHQ-9 and the GAD-7 assessments (Chart C) showed significant clinical improvement in depression and anxiety, respectively. The caption for each chart explains these findings in more detail, showing how the data create a picture of success from ERC Pathlight’s treatment.
A. Data from 1,611 adult patients and 885 child and adolescent patients collected from 2020 to 2022 showed clinically significant improvements in eating disorder symptoms.
B. Data from 996 adult patients and 570 child and adolescent patients collected from 2020 to 2022 showed clinically significant improvements in symptoms of depression (PHQ-9) and anxiety (GAD-7). Patients reported a reduction in depression symptoms, from moderate/moderately severe to mild/moderate, and anxiety symptoms, from moderate to mild, over the course of treatment at Eating Recovery Center.
C. Data from 321 adult patients and 225 adolescent patients collected from 2020 to 2022 showed clinically significant improvements in symptoms of depression (PHQ-9) and anxiety (GAD-7). Patients reported a reduction in depression symptoms, from moderate/moderately severe to mild/moderate, and anxiety symptoms, from moderate to mild, over the course of treatment at Pathlight Mood & Anxiety Center.
View Our Outcomes Data
This article first appeared in Luminary, A Magazine for Mental Health Professionals. Find more articles for additional tips, resources and insights from leading experts in the field.