Discharge Against Medical Advice in the United States, 2002-2011

Spooner, Kiara K.; Salemi, Jason L.; Salihu, Hamisu M.; Zoorob, Roger

doi:10.1016/j.mayocp.2016.12.022

Cited by 71 publications

(72 citation statements)

References 42 publications

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“…Self-discharge has been found to be more frequent among patients using alcohol or illicit drugs [2, 6]. A US nationwide register study found rates of discharge against medical advice in the range of 10–12% among patients treated for alcohol and substance related disorders compared to 1 % in general [4]. Among 34,000 patients brought by ambulance to an emergency department in a Canadian study, 55% of patients leaving without being seen had a substance abuse diagnosis, compared to 9 % among other patients [7].…”

Section: Introductionmentioning

confidence: 99%

Mortality and repeated poisoning after self-discharge during treatment for acute poisoning by substances of abuse: a prospective observational cohort study

et al. 2019

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BackgroundThough substance use is a known risk factor for self-discharge, patients self-discharging during treatment for acute poisoning have not previously been described. We charted characteristics of patients self-discharging during treatment for acute poisoning by substances of abuse looking for associations between self-discharge, repeated poisoning, and death.MethodsAll patients 12 years and older treated for acute poisoning by substances of abuse at an emergency outpatient clinic in Oslo, Norway, were included consecutively from October 2011 through September 2012. We collected data on gender, age, main toxic agent, suicidal intention, homelessness, history of severe mental illness, and self-discharge. Information on deaths was retrieved from the National Cause of Death Register. We did a multiple logistic regression analysis to look for associations between self-discharge and repeated poisoning and a Cox regression analysis for associations between self-discharge and death.ResultsDuring one year, 1731 patients were treated for 2343 episodes of acute poisoning by substances of abuse. Two-hundred-and-sixty-six (15%) patients self-discharged during at least one poisoning episode. Self-discharging patients were older, median age 39 years vs 32 years (p < 0.001), more frequently homeless, 20/266 (8%) vs 63/1465 (4%) (p = 0.035), and the main toxic agent more frequently was an opioid, 82/266 (31%) vs 282/1465 (19%) (p < 0.001). Self-discharge was an independent risk factor for repeated poisoning. The adjusted odds ratio for two or more poisoning episodes during one year among self-dischargers was 3.0 (95% CI 2.2–4.1). The association was even stronger for three or more poisoning episodes, adjusted odds ratio 5.0 (3.3–7.5). In total, there were 34 deaths, 9/266 (3.4%) among self-discharging patients and 25/1465 (1.7%) among patients not self-discharging (p = 0.12). The adjusted hazard ratio for death among self-discharging patients was 1.6 (0.75–3.6).ConclusionsSelf-discharge was associated with frequent poisonings by substances of abuse. Short-term mortality was doubled among self-discharging patients, though this increase was not statistically significant. Still, the increased risk of repeated poisoning marks self-discharging patients as a vulnerable group who might benefit from targeted post-discharge follow-up measures.

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Section: Introductionmentioning

confidence: 99%

Mortality and repeated poisoning after self-discharge during treatment for acute poisoning by substances of abuse: a prospective observational cohort study

et al. 2019

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“…Although these factors are immutable, they can be used as indicators to identify vulnerable patients who may need to improve communication to prevent AMA charge. [7] Providing a prescription at the time of discharge to patients who are about to leave AMA may reduce readmission and mortality rates in infected patients who need to complete a course of antibiotics. If the patient persists in leaving AMA, appropriate drug intervention and follow-up may play an important role after discharge.…”

Section: Discussionmentioning

confidence: 99%

“…First, as in other administrative databases, reporting biases, data loss, and coding errors are also existing in the NRD. Second, sociodemographic data, such as race, marriage and other characteristics, are associated with the AMA dischagre [7], however they are not available in the NRD. Third, the yearly datasets contained in the NRD could not be linked across the years, and the patients admitted in December were also excluded, so the prevalence of AMA discharge in this study may be underestimated.…”

Section: Discussionmentioning

confidence: 99%

“…In the U.S., about 1 to 2 percent of discharges are AMA. [7] Compared with patients who discharged routinely, patients who discharged AMA are more likely to discharge with inadequate care, and increased risk of readmission and death. [8] A study of AMI patients found that those who left AMA were more than twice as likely to be readmitted, and resulted in a mortality 57% higher.…”

Section: Introductionmentioning

confidence: 99%

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Discharge Against Medical Advice and Risk of Readmission After Sepsis Hospitalization

Lin

Zhai

Han

et al. 2020

Preprint

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Background: To describe characteristics of sepsis patients who discharged against medical advice (AMA), identify factors associated with AMA discharges in the patients, and evaluate the association of AMA discharge with 30-day unplanned readmission and outcomes of readmission.Methods: Using the National Readmission Database of the United States, we identified inpatients with sepsis who discharged AMA or discharged home between 2010 and 2017. The baseline characteristics were compared between the two groups. Multivariable models were used to identify factors related to AMA discharge, evaluate the association between AMA discharge and 30-day unplanned readmission, and elucidate the relationship between the AMA discharges and in-hospital outcomes.Results: AMA discharges accounted for 2.29% of all the hospitalized sepsis patients. The prevalence of AMA discharge in sepsis patients increased from 1.99% in 2010 to 2.55% in 2014 (p for trend < 0.001).The unplanned 30-day readmission rates of sepsis patients who discharged AMA and who discharged home are 25.51% and 12.26%, respectively. AMA discharge is statistically significantly associated with 30-day [odds ratio (OR), 2.24; 95% confidence interval (CI), 2.15–2.33], 60-day (OR, 2.07; 95% CI, 1.99–2.15), and 90-day (OR, 1.97; 95% CI, 1.90–2.05) readmission. AMA discharge is also associated with longer length of stay in 30 days (0.44 day, 95% CI, 0.12 days-0.76 days, p=0.007), whereas there was no statistically significant difference in hospitalization costs and in-hospital mortality for patients discharged AMA versus those discharged home.Conclusions: Due to the high risk of readmission, vulnerable patients should be early identified. Medical institutions should conduct post-discharge interventions for patients with AMA discharge, such as follow-up visits and psychological counseling, to reduce readmission.

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“…Notably, substance use disorders (SUDs: alcohol or drug use disorders) is among the most prevalent diagnoses in discharge against medical advice (DAMA) hospitalizations in the United States, with an estimated proportion of 14% (Spooner et al, 2017). DAMA is indicative of the receipt of inadequate treatment for SUD following an episode of SUD problems, which is associated with SUD treatment readmissions and poorer outcomes (Alfandre, 2009;Southern et al, 2012;Wines et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Discharge against medical advice from hospitalizations for substance use disorders: The potential impact of the Affordable Care Act

Zhu

2019

Drug and Alcohol Dependence

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Objectives-To explore whether the Affordable Care Act (ACA) enactment is associated with changes in the proportion of discharge against medical advice (DAMA) among hospitalizations due to substance use disorders (SUDs). Methods-Data were drawn from the 2012-2015 National Inpatient Samples. The sample comprised hospitalizations with a principal diagnosis of SUD (i.e., SUD-involved hospitalization) for patients aged 18-64 years (unweighted N=287,629). Interrupted time series analyses were conducted to evaluate the effect of the ACA on monthly proportions of DAMA among SUDinvolved hospitalizations. Results-Overall, approximately 11% of SUD-involved hospitalizations were DAMA. DAMA was most frequently found among hospitalizations for primary opioid use disorder (pre-ACA: 16.4%; post-ACA: 17.2%). Despite the increase in the Medicaid coverage after ACA enactment, there was no significant change in the proportion of DAMA before and after ACA periods across

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Discharge Against Medical Advice in the United States, 2002-2011

Cited by 71 publications

References 42 publications

Mortality and repeated poisoning after self-discharge during treatment for acute poisoning by substances of abuse: a prospective observational cohort study

Mortality and repeated poisoning after self-discharge during treatment for acute poisoning by substances of abuse: a prospective observational cohort study

Discharge Against Medical Advice and Risk of Readmission After Sepsis Hospitalization

Discharge against medical advice from hospitalizations for substance use disorders: The potential impact of the Affordable Care Act

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