The Impact of Trained Provider Teams on Diagnosis and Treatment of Eating Disorders in the Veterans Health Administration (VHA)

About This Grant

Background. Eating disorders (EDs) remain understudied in U.S. military Veterans. However, recent studies have found high rates of EDs in Veteran men and women, which did not differ by race or ethnicity, and which persisted into middle age. EDs are associated with myriad debilitating physical and mental health comorbidities, and high rates of EDs are of concern from a healthcare costs perspective. The minority of people with EDs receive treatment for them. EDs are often undetected in medical settings, and men and people of color are especially unlikely to seek or be referred for treatment. There are critical barriers to care, including availability of providers and the cost of treatment. The Veterans Health Administration (VHA) began training provider teams, which include at least one physician, therapist, and dietician, in 2017; 89 teams have been trained to date. Significance. The inception of these provider teams trained in ED treatment presents an unprecedented and timely opportunity to investigate the impact of training providers on reducing disparities and healthcare costs associated with EDs in VHA. Our aims directly address the Health Systems Research priorities of mental health, women’s health, and health equity. Innovation and Impact. No previous study has investigated whether training providers to treat EDs results in improved detection and treatment of EDs in a large healthcare system or evaluated the impact of ED provider training on racial/ethnic disparities or the total cost of treatment. Our methods capitalize on strengths of real-world observational studies, including greater generalizability, very large sample size, and inclusion of diverse groups that make it possible to evaluate racial and ethnic disparities. Our results will likely reveal that training providers in assessment and treatment of EDs will have a critical impact on detection of EDs, which will greatly improve patient health and well-being and reduce long-term costs to the healthcare system. There is a severe unmet treatment need with respect to EDs across the globe. Our findings will underscore the importance of training providers and providing resources for providers to treat EDs in large healthcare systems, in order to improve the care of men and women with EDs. Specific Aims: 1) Evaluate the effect of implementing VA provider training in ED treatment on the rates of ED diagnosis and treatment among Veterans by (a) modeling within-site change and (b) comparing sites with versus without ED provider teams from one year pre- to post-training. 2) Investigate whether racial and ethnic disparities in ED diagnoses and treatment are reduced following the provider training. 3) Evaluate the effect of implementing VA provider training in ED treatment on the rates, patterns, and costs of healthcare utilization among Veterans with diagnosed EDs. 4) Qualitatively examine a) factors associated with high/low rates of ED diagnosis and treatment following provider training and b) Veterans’ and providers’ experience with ED service delivery. Methodology. The proposed study will use a quasi-experimental design to investigate the impact of the trained provider teams. We will use data from the VHA electronic health record (EHR) to achieve Aims 1-3. For Aim 4, we will conduct qualitative interviews with ED providers and Veteran patients to investigate barriers and facilitators to implementation and sustainability of the training. Next Steps/Implementation: We have identified Dr. Jennifer Strauss, National Director, Women and Gender-Related Mental Health for the Office of Mental Health and Suicide Prevention (OMHSP), as an Operational Partner for this project. Our findings regarding the impact of the ED provider teams on ED diagnosis and treatment, as well as health disparities and healthcare costs, will be shared with OMHSP to inform ongoing training efforts and allocation of resources for these efforts. Results from the qualitative interviews also will provide opportunities for Dr. Strauss to work with individual teams to enhance their productivity and effectiveness. Our findings will underscore the importance of training clinical teams and providing resources for providers to treat EDs in large healthcare systems, in order to improve the care of men and women with EDs.