Treatment of Anorexia Nervosa in a Specialty Care Continuum Teresa A. Treat, PhD 1 * Elizabeth B. McCabe, PhD 2 Jill A. Gaskill, CRNP 2 Marsha D. Marcus, PhD 2 ABSTRACT Objective: Inpatient hospitalization has been a mainstay of treatment for an- orexia nervosa (AN), but decreasing lengths of inpatient stay have prompted the development of alternative care-con- tinuum models. This study characterizes the 6-month outcomes of 71 patients with AN who completed an inpatient- treatment protocol (5 weeks), followed by a day-hospital program (DHP) (3 weeks). Method: Data were derived from chart reviews and questionnaire data were col- lected during routine clinical care. Results: On discharge from DHP, 35.2% of patients showed excellent outcomes, whereas 23.9% exhibited poor outcomes. At 6 months after DHP discharge, 47.9% of the patients were successful in maintain- ing outpatient treatment status. Patients with successful 6-month outcomes were admitted to inpatient at a higher weight, had fewer previous hospitalizations, were younger, were rated by inpatient staff as more committed to treatment, endorsed less AN psychopathology during inpatient admission, and showed greater weight gain during DHP. Number of previous hospitalizations and weight gain immedi- ately after inpatient discharge predicted 89.2% of outcome classifications 6 months after DHP discharge. Conclusion: These findings highlight both the potential benefits of this care- continuum model for patients who previ- ously have not been hospitalized and the pressing need to develop alternative treatment strategies for patients with more chronic AN. V V C 2008 by Wiley Peri- odicals, Inc. Keywords: anorexia nervosa; psychiatric inpatients; length of stay (Int J Eat Disord 2008; 41:564–572) Introduction Anorexia nervosa (AN) is a debilitating and fre- quently chronic mental-health problem that affects 0.3–0.5% of the young female population. 1–5 His- torically, treatment of individuals with AN has included lengthy psychiatric hospitalizations, but the duration of inpatient stays for patients with AN has declined sharply in many regions of the coun- try, and the ability to restore patients to normal body weight has decreased accordingly. 6,7 In response to decreased duration of inpatient stays, we have developed a care continuum for patients with AN that includes inpatient hospitalization fol- lowed by a day-hospital program (DHP). In this manuscript, we report on the treatment trajectory of a cohort of 71 patients with AN who were admit- ted to the inpatient unit and then referred for step- down care in our DHP. We recently reported on the development and preliminary evaluation of standardized and evi- dence-based clinical pathways (or treatment proto- cols) for the inpatient treatment of persons with AN (n 5 61). 8 Pathways were designed to resolve acute medical problems, interrupt compensatory behaviors, and initiate nutritional rehabilitation, such that patients by discharge were 85% of their ideal body mass index (BMI). Although the majority of treatment completers attained the expected treatment outcomes, patients remained ill at dis- charge and clearly were in need of continued inten- sive treatment. In our setting, patients preferably step-down to an in-house DHP, which provides close monitoring and supervised meals in the con- text of structured daily programming. DHPs for patients with eating disorders began appearing in the early 1980s, in response to an increasingly pressing need for cost-effective, intensive out- patient treatment alternatives to inpatient pro- Accepted 2 May 2008 1 Department of Psychology, Yale University, New Haven, Connecticut 2 Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania *Correspondence to: Teresa A. Treat, Department of Psychology, Yale University, P.O. Box 208205, New Haven, CT 06520-8205. E-mail: teresa.treat@yale.edu Published online 20 June 2008 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/eat.20571 V V C 2008 Wiley Periodicals, Inc. 564 International Journal of Eating Disorders 41:6 564–572 2008 CE ACTIVITY