Increasing Screening for Eating Disorders in Adolescents in Primary Care

Eating disorders (EDs) are among the most lethal psychiatric illnesses and affect approximately 6–8% of adolescents worldwide, with 13% developing an ED by age 20. Despite their prevalence and associated morbidity, EDs often go undiagnosed in primary care due to inconsistent screening practices, limited provider training, and workflow barriers. Early identification significantly improves outcomes, underscoring the need for standardized screening processes in adolescent primary care settings. This Doctor of Nursing Practice (DNP) quality improvement project aimed to increase eating disorder screening and referral rates among adolescents aged 14–21 years at a suburban primary care clinic in Cary, North Carolina. The project evaluated the effect of implementing the validated InsideOut Screener (IOI-S) within a standardized workflow using the Institute for Healthcare Improvement’s Model for Improvement and Plan-Do-Study-Act (PDSA) cycles. Interventions included provider education, workflow process mapping, pre- and post-knowledge assessments, pulse checks, and biweekly data collection over a 90-day implementation period. Process measures included screening rates, provider adherence, and training completion. Outcome measures included detection and referral rates, while balancing measures assessed workflow impact. During implementation, 49 eligible adolescents were identified, and 28 were screened, resulting in a 57% screening rate. Screening rates improved during early PDSA cycles but declined during a transition between electronic health record systems. Three patients screened as high risk, and 100% received appropriate referrals to behavioral health and/or nutrition services. Pre- and post-intervention surveys demonstrated increased provider knowledge and confidence in identifying and managing eating disorders. Qualitative feedback highlighted improved workflow clarity but emphasized the need for ongoing reminders and sustained education to maintain adherence. This project demonstrated that integrating a validated ED screening tool into primary care is feasible and improves provider preparedness and referral consistency. However, sustained success requires strong leadership, workflow integration, and adaptability during system-level transitions. Standardized screening protocols and continuous education are essential to improving early identification and outcomes for adolescents at risk for eating disorders.