Variation in care for inpatients with avoidant restrictive food intake disorder leads to development of a novel inpatient clinical pathway to standardize care.

Autor: Bern EM; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 333 Longwood Avenue, 5th Floor, Boston, MA, 02115, USA. Elana.bern@childrens.harvard.edu.; Department of Pediatrics, Harvard Medical School, Boston, MA, USA. Elana.bern@childrens.harvard.edu., Milliren CE; Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA., Tsang KK; Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA.; Department of Psychiatry, Harvard Medical School, Boston, MA, USA., Mancini LA; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 333 Longwood Avenue, 5th Floor, Boston, MA, 02115, USA., Carmody JK; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 333 Longwood Avenue, 5th Floor, Boston, MA, 02115, USA.; Department of Psychiatry, Harvard Medical School, Boston, MA, USA., Gearhart MG; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 333 Longwood Avenue, 5th Floor, Boston, MA, 02115, USA., Eldredge O; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 333 Longwood Avenue, 5th Floor, Boston, MA, 02115, USA., Samsel C; Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA.; Department of Psychiatry, Harvard Medical School, Boston, MA, USA., Crowley M; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 333 Longwood Avenue, 5th Floor, Boston, MA, 02115, USA.; Department of Pediatrics, Harvard Medical School, Boston, MA, USA., Richmond TK; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
Jazyk: angličtina
Zdroj: Journal of eating disorders [J Eat Disord] 2024 May 23; Vol. 12 (1), pp. 66. Date of Electronic Publication: 2024 May 23.
DOI: 10.1186/s40337-024-01018-8
Abstrakt: Introduction: There is limited evidence to guide management of patients with avoidant restrictive food intake disorder (ARFID) admitted for medical stabilization. We describe variations in inpatient care which led to the development of a multidisciplinary inpatient clinical pathway (ICP) to provide standardized management and examine differences after the ICP was implemented.
Methods: A retrospective review of patients with ARFID admitted to Adolescent Medicine, Gastroenterology, and General Pediatrics at a single academic center was conducted. We compare hospital utilization and use of consulting services during the pre-ICP (2015-2017) and post-ICP (2018-2020) periods.
Results: 110 patients were admitted with ARFID (n = 57 pre- vs. n = 53 post-ICP). Most presented with moderate/severe malnutrition (63% pre vs. 81% post; p = 0.11) and co-morbid anxiety and/or depression (74% pre vs. 92% post; p = 0.01). There was some variation in use of enteral tube feeding by service in both periods (p = 0.76 and p = 0.38, respectively), although overall use was consistent between periods (46% pre vs. 58% post; p = 0.18). Pre-ICP, use of the restrictive eating disorder protocol differed across services (p < 0.001), with only AM using it. Overall, utilization of the restrictive eating disorder protocol decreased from 16% pre-ICP to 2% post-ICP (p = 0.02). There was variation by service in psychiatry/psychology (range 82-100% by service; p = 0.09) and social work consultations (range 17-71% by service; p = 0.001) during the pre-ICP period, though variation was reduced in the post-ICP period (p = 0.99 and p = 0.05, respectively). Implementation of the ICP led to improvements in these consultative services, with all patients in the post-ICP period receiving psychiatry/psychology consultation (p = 0.05) and an increase in social work consults from 44 to 64% (p = 0.03). Nutrition consults were consistently utilized in both periods (98% pre vs. 100% post; p = 0.33).
Conclusion: The ICP was developed to standardize inpatient medical stabilization for patients with ARFID. In this single center study, implementation of the ICP increased standardized care for inpatients with ARFID with variation in care reduced: there were improvements in the use of consulting services and a reduction in the use of the restrictive eating disorder protocol. The ICP demonstrates the potential to further standardize and improve care over time.
(© 2024. The Author(s).)
Databáze: MEDLINE
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