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Predictors of Readmission in Hospitalized Anorexia Nervosa Patients

McCabe, Elizabeth Blocher (2008) Predictors of Readmission in Hospitalized Anorexia Nervosa Patients. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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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.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
McCabe, Elizabeth
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairGreeno, Catherine GgreenoCG@upmc.eduKGREENO
Committee MemberNewhill, Christina Enewhill@pitt.eduNEWHILL
Committee MemberMarcus, Marsha Dmarcusmd@upmc.eduMMARCUS
Committee MemberGrote,
Committee MemberTreat, Teresa
Date: 15 May 2008
Date Type: Completion
Defense Date: 21 March 2008
Approval Date: 15 May 2008
Submission Date: 14 May 2008
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: School of Social Work > Social Work
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: eating disorders; relapse; managed care; readmission; anorexia nervosa
Other ID:, etd-05142008-131503
Date Deposited: 10 Nov 2011 19:44
Last Modified: 19 Dec 2016 14:36


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