Characteristics of Patients With Cirrhosis Who Are Discharged From the Hospital Against Medical Advice

Myers, Robert P.; Shaheen, Abdel Aziz; Hubbard, James; Kaplan, Gilaad G.

doi:10.1016/j.cgh.2009.03.020

Cited by 21 publications

(34 citation statements)

References 30 publications

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“…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. In an era of increasing healthcare cost containment, early identification of patients at risk for self-discharge-and, consequently, at risk for high resource use-might help reduce costs while improving hospital efficiency and quality of care.…”

Section: Discussionmentioning

confidence: 99%

“…Second, the retrospective nature of the NIS data does not allow ascertainment of the exact reasons for which patients left AMA. We were therefore unable to differentiate discharges that reflected expressions of genuine patient preference from those that reflected patient reactions to suboptimal treatment or mistreatment [19,32]. Third, we lacked data on social support (such as marital status), employment status, medications, and tobacco use, all of which could have influenced self-discharge.…”

Section: Discussionmentioning

confidence: 99%

“…Baseline comorbidity status was assessed using the Elixhauser comorbidity algorithm, which contains 30 comorbidities [12,31,35]. Four conditions included in the Elixhauser algorithm (alcohol abuse, drug abuse, psychosis, and AIDS/HIV infection) were analyzed separately, because they have been previously associated with self-discharge [22,32], thus leaving 26 comorbidities for summation (Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…Factors associated with self-discharge have been documented in numerous settings of healthcare delivery [4,10,20,22,32,36]. Most studies suggest that patients leaving against medical advice are either socioeconomically disadvantaged or have psychiatric illness [22,24,32,33,38].…”

Section: Introductionmentioning

confidence: 99%

“…Most studies suggest that patients leaving against medical advice are either socioeconomically disadvantaged or have psychiatric illness [22,24,32,33,38]. However, we do not know whether patients who leave the hospital before their caregivers recommend discharge after common emergency orthopaedic conditions such as fractures and infections share similar demographic characteristics.…”

Section: Introductionmentioning

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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Menendez

Dijk

Ring

2015

Clinical Orthopaedics &Amp; Related Research

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Impact of liver disease on outcomes of patients hospitalized for epistaxis

et al. 2017

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Associations of Mental, and Medical Illnesses With Against Medical Advice discharges: The National Hospital Discharge Survey, 1988–2006

Tawk

Freels

Mullner

2011

Adm Policy Ment Health

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This study examined the association of mental and medical illnesses with the odds for leaving against medical advice (AMA) in a national sample of adult patients who left general hospitals between 1988 and 2006. Leaving AMA was first examined as a function of year and mental illness. Multiple logistic regression analysis was then used to adjust for patient and hospital characteristics when associating mental and major medical diagnoses with AMA discharges. The results indicated that leaving AMA was most strongly associated with mental health problems. However, the impact of mental illness was attenuated after adjusting for medical illnesses, patient and hospital characteristics. The strongest predictors of AMA discharge included being self-pay, having Medicaid insurance, being young and male, and the regional location of the hospital (Northeast). When substance abuse conditions were excluded from the mental illness discharge diagnoses, mental illness had lower odds for leaving AMA. The results may be of value to clinicians, and hospital administrators in helping to profile and target patients at risk for treatment-compliance problems. Prospective primary data collection that would include patient, physician, and hospital variables is recommended.

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Characteristics of Patients With Cirrhosis Who Are Discharged From the Hospital Against Medical Advice

Cited by 21 publications

References 30 publications

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

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

Impact of liver disease on outcomes of patients hospitalized for epistaxis

Associations of Mental, and Medical Illnesses With Against Medical Advice discharges: The National Hospital Discharge Survey, 1988–2006

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