title: An eleven site national quality improvement evaluation of adolescent medicine-based eating disorder programs: predictors of weight outcomes at one year and risk adjustment analyses.
abstract: OBJECTIVE
  This quality improvement project collected and analyzed short-term weight gain data for patients with restrictive eating disorders (EDs) treated in outpatient adolescent medicine-based ED programs nationally.
  
  
  METHODS
  Data on presentation and treatment of low-weight ED patients aged 9-21 years presenting in 2006 were retrospectively collected from 11 independent ED programs at intake and at 1-year follow-up. Low-weight was defined as < 90% median body weight (MBW) which is specific to age. Treatment components at each program were analyzed. Risk adjustment was performed for weight gain at 1 year for each site, accounting for clinical variables identified as significant in bivariate analyses.
  
  
  RESULTS
  The sites contained 6-51 patients per site (total N = 267); the mean age was 14.1-17.1 years; duration of illness before intake was 5.7-18.6 months; % MBW at intake was 77.5-83.0; and % MBW at follow-up was 88.8-93.8. In general, 40%-63% of low weight ED subjects reached ≥90% MBW at 1-year follow-up. At intake, patients with higher % MBW (p = .0002) and shorter duration of illness (p = .01) were more likely to be ≥90% MBW at follow-up. Risk-adjusted odds ratios controlled for % MBW and duration of illness were .8 (.5, 1.4)-1.3 (.3, 3.8), with no significant differences among sites.
  
  
  CONCLUSIONS
  A total of 11 ED programs successfully compared quality improvement data. Shorter duration of illness before intake and higher % MBW predicted improved weight outcomes at 1 year. After adjusting for risk factors, program outcomes did not differ significantly. All adolescent medicine-based ED programs were effective in assisting patients to gain weight.
authors.affiliation: Division of Adolescent/Young Adult Medicine, Children's Hospital Boston, Boston, Massachusetts 02115, USA. sara.forman@childrens.harvard.edu
authors.forename: Sara F
authors.initials: SF
authors.lastname: Forman
authors.forename: Leah F
authors.initials: LF
authors.lastname: Grodin
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.forename: Cara J
authors.initials: CJ
authors.lastname: Sylvester
authors.forename: David S
authors.initials: DS
authors.lastname: Rosen
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Kapphahn
authors.forename: S Todd
authors.initials: ST
authors.lastname: Callahan
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Sigel
authors.forename: Terrill
authors.initials: T
authors.lastname: Bravender
authors.forename: Rebecka
authors.initials: R
authors.lastname: Peebles
authors.forename: Mary
authors.initials: M
authors.lastname: Romano
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Rome
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
authors.forename: Joan B
authors.initials: JB
authors.lastname: Malizio
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Mammel
authors.forename: Albert C
authors.initials: AC
authors.lastname: Hergenroeder
authors.forename: Sara M
authors.initials: SM
authors.lastname: Buckelew
authors.forename: Neville H
authors.initials: NH
authors.lastname: Golden
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Woods
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine; D001835:Body Weight; D002648:Child; D001068:Feeding and Eating Disorders / Q000517:prevention & control*; D005260:Female; D006293:Health Promotion / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D016017:Odds Ratio; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D020379:Risk Adjustment; D014481:United States; D055815:Young Adult