Characteristics and outcomes of discharges against medical advice among hospitalised patients

Yong, Tuck Yean; Fok, Jie Shen; Hakendorf, Paul; Ben-Tovim, David I.; Thompson, Campbell; Li, Jordan

doi:10.1111/imj.12109

Cited by 93 publications

(106 citation statements)

References 16 publications

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“…12,14 Homeless patients were also overrepresented in the AMA discharge population at Highland Hospital-a finding that has not been consistently reported in prior studies, and that warrants further examination. In adjusted analyses, Spanish speakers had a lower rate of AMA discharge, and there were no racial variations.…”

Section: Discussionmentioning

confidence: 68%

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Stearns¹,

Bakamjian²,

Sattar³

et al. 2017

Journal of Hospital Medicine

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Section: Discussionmentioning

confidence: 68%

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Stearns¹,

Bakamjian²,

Sattar³

et al. 2017

Journal of Hospital Medicine

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“…Discharges AMA might lead to adverse outcomes, readmissions to the hospital, and disproportionate use of healthcare resources for patients because of inadequate initial treatment of a medical condition [1,6,17,21,44]. Although rates and risk factors for self-discharge have been documented in other settings, including pneumonia [36], asthma [4], and gastrohepatic disorders [22,32], there has been little published regarding orthopaedic patients.…”

Section: Discussionmentioning

confidence: 99%

“…Although the observed frequency of self-discharge episodes-particularly among hospitalizations for fractures-could be considered small, the clinical and economic burden to healthcare systems may be substantial. On the basis of available evidence, it is likely that more than 21,000 patients who left prematurely after a fracture ended up having more adverse events and readmissions, ultimately resulting in higher healthcare costs-some of which are often not reimbursed to hospitals by insurance companies [6,17,44]. Aliyu [2] calculated the readmission cost resulting from a self-discharge at 56% higher than expected from the original hospitalization.…”

Section: Discussionmentioning

confidence: 99%

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Who Leaves the Hospital Against Medical Advice in the Orthopaedic Setting?

Menendez

Dijk

Ring

2015

Clinical Orthopaedics &Amp; Related Research

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Background Patients who leave the hospital against medical advice are at risk for readmission and for a variety of complications and are likely to consume more healthcare resources. However, little is known about which factors, if any, may be associated with self-discharge (discharge against medical advice) among orthopaedic inpatients. Questions/purposes We studied the frequency and factors associated with self-discharge in patients hospitalized for orthopaedic trauma and musculoskeletal infection. Methods Using discharge records from the Nationwide Inpatient Sample (2002-2011), we identified approximately 7,067,432 patient hospitalizations for orthopaedic trauma and 5,488,686 for musculoskeletal infection. We calculated the proportions of admissions that ended in selfdischarge for both trauma and infection patients; then, we examined patient demographics, diagnoses, and hospital factors. Multivariable logistic regression models were constructed to determine independent predictors of selfdischarge. Results Approximately one in 333 (0.3%) patients hospitalized for an isolated fracture and one in 47 (2.1%) patients with musculoskeletal infection left against medical advice. Patient characteristics associated with self-discharge included age \ 75 years (trauma: odds ratio [OR] 2.7, 95% confidence interval [CI] 2.5-2.8, p \ 0.001; infection: OR 3.9, 95% CI 3.8-4.1, p \ 0.001), male sex (trauma: OR 1.7, 95% CI 1.7-1.8, p\0.001; infection: OR 1.4, 95% CI 1.3-1.4, p \ 0.001), black race/ethnicity (trauma: OR 1.5, 95% CI 1.4-1.6, p\0.001; infection: OR 1.1, 95% CI 1.1-1.1, p \ 0.001), low household income (trauma: OR 1.5, 95% CI 1.4-1.5, p\0.001; infection: OR 1.4, 95% CI 1.4-1.4, p \ 0.001), nonprivate insurance (Medicare [trauma: OR 1.7, 95% CI 1.6-1.8, p \ 0.001; infection: OR 2.5, 95% CI 2.4-2.5, p \ 0.001] and Medicaid [trauma: OR 2.6, 95% CI 2.5-2.7, p \ 0.001; infection: OR 3.2, 95% CI 3.2-3.3, p \ 0.001]), and no insurance coverage (trauma: OR 3.0, 95% CI 2.9-3.1, p \ 0.001; infection: OR 3.5, 95% CI 3.4-3.5, p \ 0.001), less medical comorbidity (trauma: OR 0.94 per one-unit increase in the number of comorbidities, 95% CI 0.93-0.95, p\0.001; infection: OR 0.88, 95% CI 0.87-0.88, p\ 0.001), alcohol (trauma: OR, 2.3, 95% 2.2-2.4, p \ 0.001; infection: OR 1.5, 95% CI 1.5-1.5, p \ 0.001), opioid (trauma: OR 2.9, 95% CI 2.7-3.1, p\0.001; infection: OR 4.4, 95% CI 4.3-4.4, p \ 0.001) and nonopioid drug abuse (trauma: OR, 2.0, 95% CI 1.9-2.1, p \ 0.001; infection: OR 2.8, 95% CI 2.8-2.9, p \ 0.001), psychosis (trauma:Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. 3, 95%CI 1.2-1.3, p\0.001; infection: OR 1.3, 95% CI 1.3, 1.4, p \ 0.001), and AIDS/HIV infection (trauma: OR 1.5, 95% CI 1.2-1.8, p\0.001; infection: OR 1.3, 95% CI 1.3-1.4, p \ 0.001). Patients with upper...

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“…10,44 Several retrospective studies have identified patients with substance use disorders as having a high risk of discharge against medical advice, which is associated with increases in hospital readmissions and health care costs, as well as in the risk of death, highlighting the importance of prevention. [45][46][47][48] Qualitative research and one systematic review found that opioid withdrawal, inadequate pain management, younger age, daily heroin injection and unstable employment were factors contributing to discharges against medical advice among patients with substance use disorders. 29,49,50 Available evidence suggests that opioid agonist therapy, when paired with referral to outpatient addiction services, may reduce discharge against medical advice and increase engagement in postdischarge addiction treatment.…”

Section: Is There Benefit To Inpatient Initiation Of Opioid Agonist Tmentioning

confidence: 99%

Caring for patients with opioid use disorder in the hospital

Donroe

Holt

Tetrault

2016

CMAJ

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Characteristics and outcomes of discharges against medical advice among hospitalised patients

Abstract: Patients who self-discharged against medical advice carry a significant risk of readmission and mortality. Patients with characteristics of 'at risk of DAMA' should have greater attention paid to their care before and especially after any premature discharge.

Cited by 93 publications

References 16 publications

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Discharges Against Medical Advice at a County Hospital: Provider Perceptions and Practice

Who Leaves the Hospital Against Medical Advice in the Orthopaedic Setting?

Caring for patients with opioid use disorder in the hospital

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