Predictors of Outpatient and Inpatient Service Utilization Among Publicly-Insured Youth With Eating Disorders

Megan E Mikhail; Kate Duggento Cordell; Amanda E Downey; Lonnie R Snowden; Erin C Accurso

doi:10.1002/eat.24301

Predictors of Outpatient and Inpatient Service Utilization Among Publicly-Insured Youth With Eating Disorders

Int J Eat Disord. 2024 Oct 24. doi: 10.1002/eat.24301. Online ahead of print.

Authors

Megan E Mikhail^{1

2}, Kate Duggento Cordell^{3

4

5}, Amanda E Downey^{1

6}, Lonnie R Snowden⁷, Erin C Accurso^{1

8}

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.
² Michigan State University, East Lansing, Michigan, USA.
³ Mental Health Data Alliance, Folsom, California, USA.
⁴ Center for Innovation in Population Health, University of Kentucky, Lexington, Kentucky, USA.
⁵ Social Policy Institute, San Diego State University, San Diego, California, USA.
⁶ Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA.
⁷ School of Public Health, University of California, Berkeley, California, USA.
⁸ Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, California, USA.

PMID: 39444291
DOI: 10.1002/eat.24301

Abstract

Introduction: Although eating disorders (EDs) affect youth from all socioeconomic backgrounds, little is known about the treatment experiences of under-resourced youth with EDs. To address this gap, we examined patterns of outpatient and inpatient service utilization among publicly-insured youth with EDs in California and potential disparities for youth with additional marginalized identities.

Method: Participants were identified from the full sample of California Medicaid/Medi-Cal beneficiaries aged 7-18 with ≥ 1 service episode between January 1, 2014 and December 31, 2016. Claims data were extracted for youth with a full year of claims after the first known ED diagnosis (N = 3311) to analyze outpatient mental health, outpatient medical/physical, inpatient mental health, and inpatient medical/physical service use across ED diagnosis and demographic characteristics (sex, age, race/ethnicity, and preferred language).

Results: Outpatient individual and family therapy service utilization was low across ED diagnoses (4-7 individual therapy sessions and ≈5 family therapy sessions annually). Conversely, hospitalization rates were high, particularly among youth with anorexia nervosa (27.8%) and bulimia nervosa (30.0%). Youth with other specified feeding or ED had high medical service utilization, with more days of outpatient medical care and greater odds of medical hospitalization than youth with all other diagnoses. Latinx youth, Black youth, and boys tended to receive fewer services after accounting for diagnosis, with disparities particularly pronounced for Latinx youth.

Conclusions: Publicly-insured youth with EDs in California experience high hospitalization rates but receive limited outpatient therapy. Additional research is needed to identify possible unmet needs and factors contributing to treatment disparities among these youth.

Keywords: Medicaid; anorexia nervosa; bulimia nervosa; disadvantage; eating disorders; health disparities; other specified feeding or eating disorders; treatment; youth.

Abstract

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