Joint Commission Releases New Standards for Eating Disorder Programs

In July, the Joint Commission—an agency that accredits and certifies nearly 21,000 health care organizations and programs in the United States—implemented new requirements for behavioral health care organizations that provide care for people with eating disorders.

Joint Commission accreditation and certification are recognized nationwide as symbols of quality that reflect an organization’s commitment to meeting certain performance standards.

The standards—which are based in part on the APA Practice Guideline for the Treatment of Patients With Eating Disorders, Third Edition—were developed in response to concerns that some organizations purporting to offer eating disorders programs may not be providing adequate behavioral and physical health care services to patients.

“A lot of things are changing in the field of eating disorders,” said Angela Guarda, M.D., director of the Johns Hopkins Eating Disorders Program, one of the few remaining academic programs that offers inpatient, partial hospital, and outpatient treatment for eating disorders.

When managed care in the United States dramatically shortened hospital stays for eating disorders in the 1990s, more patients began seeking care at private residential programs, Guarda told Psychiatric News. In fact, according to an analysis by Guarda and colleagues that appeared June 1 in Psychiatric Services, the number for such residential programs in the United States jumped from 22 facilities in 2002 to 75 facilities in March.

“Although facility standards are being established for residential treatment, there is still no industry consensus about either the care components required to accomplish treatment goals or benchmarks for assessing quality of care,” Guarda and colleagues wrote. “Most programs provide some evidence-based treatments, such as cognitive-behavioral therapy, but many also offer treatments that lack empirical support but are attractive to patients, such as equine therapy, dance, or drama.”

Additionally, peer-reviewed evaluation of the effectiveness of these residential programs is scant, which has some experts in eating disorders, including Guarda, concerned.

“[E]ating disorders have the highest mortality rate of any behavioral health disorder,” David Baker, M.D., M.P.H., executive vice president of the Division of Health Care Quality Evaluation at the Joint Commission, said in a press release. “This makes it very important that these programs provide the safest, highest quality care possible. With the new standards … we aim to provide Joint Commission–accredited organizations with the tools they need to improve care and treatment for these individuals.”

The new eating disorder standards for behavioral health care address 11 critical aspects of care, which are summarized in four categories.

• Assessment: Collect and analyze necessary data, as determined by the organization, from patient at admission and discharge to effectively treat the patient and as a measure of the organization’s effectiveness in treating eating disorders.

• Treatment: Cover specific core care, treatment, or service components that are provided by the organization to individuals with eating disorders, including psychosocial, medical, nutritional, and psychiatric components, and maintain a line of communication with other medical facilities that may be providing care to a patient while he or she is in rehabilitation for an eating disorder.

• Family Involvement: Engage family members of patients who have not acknowledged the organization’s efforts to involve them in the individual’s care, treatment, or services, in accordance with the needs and preferences of the individual served.

• Organizational Practices and Policies: Supply patients and their families with information regarding insurance and financial assistance and ensure that residential facilities have specific policies regarding the individual’s ability to leave the facility, have visitors, and access the Internet.

Guarda told Psychiatric News that while she believes the new standards will serve to help patients with eating disorders, she would like to have seen more details relating to assessing treatment outcomes.

“It’s unclear whether measurements of certain outcomes are necessary for Joint Commission accreditation,” said Guarda. “The standards are giving the organizations power to decide what critical data should be collected. For example, successful treatment of anorexia requires both assessment of eating behaviors and weight gain in patients,” she explained. “Improvements in eating behaviors are not enough; there has to be a weight gain associated with the measure of success.” ■