Objective: Managed care practices that limit access to and duration of treatment conflict with established standards of care for patients with anorexia nervosa (AN). However, there is little information about how abbreviated lengths of hospitalization relate to the need for rehospitalization, one indicator of unfavorable outcome. This dissertation describes the demographic and clinical features of patients who require multiple psychiatric hospitalizations for treatment of AN and identifies patient characteristics that predict both likelihood of and time to readmission in the current care environment. Method: One-hundred-forty-seven patients with a primary diagnosis of AN and hospitalized on a specialized eating disorders psychiatric unit completed self-report questionnaires measuring eating disorders symptoms, mood, and personality functioning at admission and discharge. Medical record reviews yielded demographic, historical, and inpatient course of treatment information. Medical records were later reviewed to determine which of the 147 patients had been readmitted to the same facility within 3 years of their index admission. Multivariate logistic regression analysis was used to evaluate prediction of readmission status. Cox regression survival techniques were used to evaluate prediction of time to readmission. Parallel analyses were conducted on the full sample (n = 147) and on a subsample of patients (n=107) who were not discharged against medical advice (i.e., received an adequate dose of treatment). Results: Twenty-seven percent of the full sample and 31% of the subsample were readmitted within 3 years of their discharge. Body dissatisfaction and mood disorder diagnosis at discharge best predicted the likelihood of both readmission and time to readmission for the group of patients who received an adequate dose of inpatient treatment. Discussion: The observed predictors differ from those typically associated with readmission in patients with AN. The findings highlight the centrality of psychopathological aspects of AN and comorbid mood disorder, and they suggest a need to refine inpatient treatment interventions to more specifically target the psychological distress associated with body image disturbances and mood disorder. More broadly, the findings suggest the need to further evaluate the extent to which the managed care treatment environment is affecting treatment outcomes.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-05142008-131503 |
| Date | 15 May 2008 |
| Creators | McCabe, Elizabeth Blocher |
| Contributors | Christina E. Newhill, Ph.D., Catherine G. Greeno, Ph.D., Marsha D. Marcus, Ph.D., Teresa A. Treat, Ph.D., Nancy Grote, PhD |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-05142008-131503/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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