Discharges Against Medical Advice: Prevalence, Predictors, and Populations

Nagarajan, Madhuram; Offurum, Ada Ibe; Gulati, Mangla; Onukwugha, Eberechukwu

doi:10.1007/978-3-319-75130-6_2

Cited by 3 publications

(7 citation statements)

References 47 publications

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“…These findings can help guide the implementation of appropriate patient-and system-level interventions to optimize DAMA prevention and mitigate the associated utilization burden on the healthcare system in the postdischarge period. 26,27 Our findings should be interpreted with certain limitations in mind. First, this study used data based on a commercially insured sample of patients and may not be generalizable to pub-licly insured or uninsured samples.…”

Section: Discussionmentioning

confidence: 86%

“…Our results provide a comprehensive understanding of utilization outcomes in this population including those outside the inpatient setting, which has been the focus of prior literature. These findings can help guide the implementation of appropriate patient‐ and system‐level interventions to optimize DAMA prevention and mitigate the associated utilization burden on the healthcare system in the postdischarge period 26,27 …”

Section: Discussionmentioning

confidence: 99%

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Healthcare Resource Utilization Following a Discharge Against Medical Advice: An Analysis of Commercially Insured Adults

Gandhi

Onukwugha

McRae

et al. 2020

Journal of Hospital Medicine

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BACKGROUND: A discharge against medical advice (DAMA) is associated with adverse health outcomes. Its association with postdischarge healthcare resource utilization (HcRU) outside an inpatient setting is unknown. This information can help us understand how a DAMA may affect healthcare-seeking behavior following a hospital stay. We evaluated the relationship between a DAMA and 30-day postdischarge HcRU. METHODS: This retrospective cohort study uses a 10% random sample of enrollees in the IQVIA PharMetrics® Plus database. We included individuals aged 18 to 64 years with an inpatient admission during 2007-2015 and continuous insurance coverage. We defined comparison groups as DAMA and routine discharge. Both groups were matched on baseline covariates. We quantified the association between a DAMA and 30-day HcRU, as well as 90-day for sensitivity analysis, with use of generalized linear models for binary outcomes (inpatient readmissions, emergency department [ED] visits) and count outcomes (physician office visits, nonphysician outpatient encounters, prescription drug fills). RESULTS: Of the 457,530 individuals in the unmatched sample, 2,245 (0.5%) had a DAMA. In the matched sample, a DAMA was positively associated with an ED visit (adjusted odds ratio, 2.28; 95% confidence interval, 1.90-2.72) but not with an inpatient readmission. There were no differences between groups based on the count outcomes. A DAMA was positively associated with 90-day HcRU (ie, inpatient readmission, ED visit, and prescription drug fills). CONCLUSION: The relationship between a DAMA and HcRU varied with the HcRU category and postdischarge time interval. This examination of HcRU in the inpatient and outpatient settings provides important information about outcomes following a DAMA.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Healthcare Resource Utilization Following a Discharge Against Medical Advice: An Analysis of Commercially Insured Adults

Gandhi

Onukwugha

McRae

et al. 2020

Journal of Hospital Medicine

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“…Younger age was often predictive of early discharge in the studies included in this review, such as Brorson et al . 's [10] review examining dropout from all types of addictions treatment, and in the general literature regarding early discharges from acute care settings [19]. Younger age has been associated with impulsivity and it has been hypothesised that this may influence young people's decisions to leave early [10].…”

Section: Discussionmentioning

confidence: 99%

“…In the general literature regarding AMA discharges from acute care hospitals, factors such as urban location, medium or large hospital size and low‐income areas were associated with early discharge [19]. These factors, in addition to variables characterising training and experience of staff, staffing complement and programming offered may be worth examining in the withdrawal management context using multi‐site studies which permit comparison of different services.…”

Section: Discussionmentioning

confidence: 99%

“…This approach was informed by Nagarajan et al . [19], who used an ecological systems framework to organise the findings of their literature review examining early discharges from acute care settings. Each variable was then listed in a table, with columns indicating which studies reported the variable to be statistically significant and which did not.…”

Section: Methodsmentioning

confidence: 99%

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Predictors of and reasons for early discharge from inpatient withdrawal management settings: A scoping review

Ling

Davies

Sproule

et al. 2021

Drug and Alcohol Review

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Issues Early discharges, also known as ‘against medical advice’ discharges, frequently occur in inpatient withdrawal management settings and can result in negative outcomes for patients. The purpose of this scoping review is to identify what is known about predictors of and reasons for the early discharge among adults accessing inpatient withdrawal management settings. Approach MEDLINE, CINAHL, PsycINFO, ASSIA and EMBASE were searched, resulting in 2587 articles for screening. Title and abstract screening and full‐text review were completed by two independent reviewers. Results were synthesised in quantitative and qualitative formats. Key Findings Sixty‐two studies were included in this scoping review. All studies focused on predictors of early discharge, except one which only described reasons for the early discharge. Forty‐eight percent of studies involved retrospective review of health records data. The most frequently examined variables were demographics. Variables related to the treatment setting, such as referral source and treatment received, were examined less frequently but were more consistently associated with early discharge compared to demographics. Only six studies described patient reasons for the early discharge, which were retrieved via clinical documentation. The most common reasons for early discharge were dissatisfaction with treatment and family issues. Implications and Conclusions Most demographic variables do not consistently predict early discharge, and reasons for early discharge are not well understood. Future studies should focus on the predictive value of non‐patient‐level variables, or conduct analyses to account for predictors of early discharge among different subgroups of people (e.g. by gender or ethnicity). Qualitative research exploring patient perspectives is needed.

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The Right to Refuse: Understanding Healthcare Providers’ Perspectives on Patient Autonomy in Emergency Care

Al-Wathinani,

Barten,

Alsahli

et al. 2023

Healthcare

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Healthcare providers in prehospital care and emergency departments are often at the frontline of medical crises, facing a range of ethical dilemmas, particularly when it comes to patients refusing treatment. This study aimed to delve into the attitudes of these providers toward treatment refusal, unearthing the strategies they employ in navigating such challenging situations while actively working in prehospital emergency health services. Our findings showed that, as the participants’ age and experience increased, so did their inclination to respect patient autonomy and avoid persuading them to change their decision about treatment. It was noted that doctors, paramedics, and emergency medical technicians demonstrated a deeper understanding of patients’ rights than other medical specialists. However, even with this understanding, the prioritization of patients’ rights tended to diminish in life-threatening situations, giving rise to ethical dilemmas. This underlines the complexity of balancing the healthcare professionals’ responsibilities and the patients’ autonomy, which can generate ethically challenging scenarios for those working in emergency healthcare. By investigating these attitudes and experiences, this study seeks to foster a more profound understanding of the ethical quandaries faced by emergency healthcare providers. Our ultimate aim is to contribute to the development of effective strategies that support both patients and professionals in managing these tough circumstances.

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Discharges Against Medical Advice: Prevalence, Predictors, and Populations

Cited by 3 publications

References 47 publications

Healthcare Resource Utilization Following a Discharge Against Medical Advice: An Analysis of Commercially Insured Adults

Healthcare Resource Utilization Following a Discharge Against Medical Advice: An Analysis of Commercially Insured Adults

Predictors of and reasons for early discharge from inpatient withdrawal management settings: A scoping review

The Right to Refuse: Understanding Healthcare Providers’ Perspectives on Patient Autonomy in Emergency Care

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