Relapse and readmission rates after hospital-based treatment of anorexia nervosa (AN) are unacceptably high, placing a major financial, psychological, and social burden on patients and family members. We propose the application of a Health Information Technology (HIT) service to bridge the transition between higher levels of care (i.e., inpatient, partial hospitalization, residential) and outpatient care with the goal of reducing relapse and readmission. This proposal in response to RFA-PA-09-164 "NIH Exploratory/Developmental Research Grant Program (Parent R21)", describes the development and feasibility testing of an iPhone-based HIT service, iEAT: Information Technology to Enhance Anorexia Treatment, that will serve as a self-monitoring and communication tool for patients with AN and their providers. The transition to outpatient care is marked by a dramatic decrease in provider contact and increased exposure to potentially triggering environmental factors. By providing this self-monitoring and communication bridge, we aim to ease the transition between levels of care. iEAT will augment weekly outpatient treatment by allowing patients and providers to monitor and manage AN-related symptoms and behaviors thereby increasing and improving patient self-care and communication with their providers. We will develop IEAT in 3 stages involving stakeholders (patients and providers) at each step. In Stage 1, we will conduct in-depth interviews with patients and providers to fully understand needs and develop iEAT. In Stage 2, we will beta-test the program with 4 patients and their providers. Feedback will inform the final version of the application which will then be tested in Stage 3 in an uncontrolled trial of 10 patients and their providers. Patients will be trained in the use of the iEAT enabled iPhones prior to hospital discharge and providers will participate via iPhone or web interface. Patients will input daily entries of dietary exchanges, thoughts, mood, and urges to restrict and purge, as well as other variables that emerge from Stage 1 and 2 testing. Patients will receive automated feedback messages based on their entries, prompts when entries are missed, scheduled individualized feedback from their provider, and weekly treatment team feedback regarding progress towards treatment goals. iEAT will allow patients and providers to view summaries of their daily entries as well as clinical data collected during weekly outpatient visits (e.g., weight, self-report measures). At four months post-discharge, iEAT will be evaluated based on validity of entries, adherence, frequency and quality of the data entries over time, as well as patient and provider reports on its utility and acceptability. iEAT will then be tested formally in a subsequent larger randomized controlled trial to determine whether it enhances post-discharge maintenance of treatment goals and decreases readmission. iEAT has the potential to ease the transition between levels of care and provide a cost-effective and user- friendly approach to increase patient-provider contact, enhance self-monitoring of symptoms, and decrease hospital readmission for individuals with AN.
Treatment for anorexia nervosa (AN) is expensive and is marked by frequent relapse and re-hospitalization. iEAT has the potential to ease the transition between levels of care and provide a cost-effective and user- friendly approach to increase patient-provider contact, enhance self-monitoring of symptoms, and decrease hospital readmission for individuals with AN. The technology developed here will be made available through other mobile phone platforms and readily modifiable for management of other psychiatric and medical conditions.