Effects of a Digital Therapeutic Adjunct to Eating Disorder Treatment on Healthcare Service Utilization and Clinical Outcomes: A Retrospective Analysis Using Electronic Health Records (Preprint)

BACKGROUND Treatment for eating disorders delivered and enhanced via digital therapeutics has shown promise to improve patient outcomes, yet has so far seen mixed results. Questions remain regarding the impact of application (app)-augmented in-person eating disorder (ED) therapy in clinical practice, including the effect on service utilization. OBJECTIVE To examine the effects of app-augmented treatment on clinical outcomes and healthcare utilization for patients receiving treatment for an ED in outpatient and intensive outpatient levels of care. METHODS Recovery Record was implemented in outpatient and intensive outpatient services in a California-based Health Maintenance Organization (HMO). We examined outcomes for eligible patients with eating disorders by comparing clinical and service utilization medical record data over a six-month period post implementation with analogous data for the control group in the year prior. We used a logistic regression model and inverse-weighted estimates of the probability of treatment to adjust for treatment selection bias. RESULTS App-augmented treatment was associated with a significant decrease in emergency department visits (p < .001) and a significant increase in outpatient treatment utilization (p< .0001). There was a significantly larger weight gain for patients in low weight categories (i.e., underweight, anorexia, or severe anorexia) with app-augmented treatment (treatment effect = 0.74, 0.25, 0.35, respectively; p=.02), with a greater percentage of patients moving into a higher BMI class (p=.01). CONCLUSIONS Given the demonstrated differences between patient populations and protocols in randomized trials and real-world clinical practice, understanding the real-world efficacy of app- augmented therapy is critical in the large-scale integration of innovative app-based therapy into practice.