Php11 Ethnic Disparities in Hospital Discharges Against Medical Advice Among Cardiovascular Disease Patients:the Role of Hospital Quality

Onukwugha, E.; Weir,; Saunders, Elaine; Shaya, FT

doi:10.1016/s1098-3015(10)70110-8

Cited by 8 publications

(10 citation statements)

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“…Healthcare priorities should then move to providing the best possible medical care for the patient in the context of his or her life. In a study among patients with cardiovascular disease, DAMA was negatively correlated with higher quality hospitals where quality measurement included survey data from patient experience domains such as communication with nurses, responsiveness of hospital staff, cleanliness, pain management and communication about medicines 18. In another example, interviews with patients with substance use disorders reveal an intense perceived stigmatisation by healthcare providers 19.…”

Section: Rethinking Discharge Against Medical Advice As a Healthcare mentioning

confidence: 99%

Discharge against medical advice: ‘deviant’ behaviour or a health system quality gap?

et al. 2019

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Section: Rethinking Discharge Against Medical Advice As a Healthcare mentioning

confidence: 99%

Discharge against medical advice: ‘deviant’ behaviour or a health system quality gap?

et al. 2019

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“…Because AMA discharge rates are affected not just by patient factors, but by hospital and health system factors, 5 the HRRP may act along with local factors to influence adverse discharge outcomes. The HRRP's exclusion of AMA discharges in the calculation of readmission penalties may provide a financial incentive that could affect AMA discharge practices.…”

Section: Discussionmentioning

confidence: 99%

Against Medical Advice Discharges Are Increasing for Targeted Conditions of the Medicare Hospital Readmissions Reduction Program

Onukwugha

Alfandre

2019

J GEN INTERN MED

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“…This is in keeping with findings from other studies in Africa and differs slightly from studies from the USA where substance abuse, race (may be related to economic power) and lack of health insurance play a major role. [2,7,12,14,19] An Italian study gave personal and family problems and refusal of treatment as reasons for DAMA. [25] CONCLUSION The incidence of discharge against medicine is high in this study.…”

Section: Discussionmentioning

confidence: 99%

“…[1,2,18] Other factors that may influence the decision to self-discharge include race, severity of disease condition (diagnosis), quality of hospital and lack of the attending physician. [6,12,19] Knowing the profiles of DAMA on the medical wards is very important as it allows for evidence-based interventions to reduce to a minimum this problem. To the knowledge of the authors, there is no study on DAMA specifically among medical inpatients in West Africa.…”

Section: Introductionmentioning

confidence: 99%

Discharge against medical advice: Experience from a rural Nigerian hospital

et al. 2013

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A B S T R A C TIntroduction: Discharge against medical advice (DAMA) is a worldwide problem with negative health and socioeconomic effects. Factors that have been implicated as causes or contributing to DAMA include fi nancial constraints, lack of health insurance, deteriorating clinical condition of the patient, and problematic doctorpatient relationships. Aims: To determine the incidence and profi les of DAMA on the medical wards, so as to allows for evidencebased interventions to reduce this problem to a minimum. Materials and Methods:This was a case-control study carried out on the medical wards of Federal Medical Center, Ido-Ekiti, South-West Nigeria. The medical records of all patients admitted to the male and female medical wards between January 2008 and April 2011 were reviewed. After being identifi ed through the admission/discharge log, patients who were DAMA and a similar number of patients with regular discharge had their case notes retrieved. Information extracted included bio-data, diagnosis, duration of hospital stay, and reason for discharge. Results: One hundred and thirty-eight patients representing 7.2% were DAMA during the study period. Ninety fi ve cases had complete medical records, and full analysis was carried out on these and 94 other cases with regular discharge as control. The mean age of the DAMA cases was 50.8 ± 18.3 years, with 58 (61.1%) of these patients being male; while the mean age of the control group was 54.1 ± 16.5, of which 54 (57.4%) were male. The mean duration of admission for patients with DAMA was 10.4 ± 9.2 days as against 11.9 ± 10 in the control group, a difference that is not statistically signifi cant. The associations between type of discharge, sex, and duration of admission are shown through odds ratios of 0.883 and 0.833 respectively. Financial problems (48%), lack of clinical improvement (28.8%) and leaving to seek alternative/complimentary medical care (23.1%) were the factors found to be responsible for DAMA in the study. Conclusion: The incidence of discharge against medicine is high in this study. There is a need for all stakeholders to evaluate factors responsible for DAMA, with the aim of reducing this trend.

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Php11 Ethnic Disparities in Hospital Discharges Against Medical Advice Among Cardiovascular Disease Patients:the Role of Hospital Quality

Cited by 8 publications

References 0 publications

Discharge against medical advice: ‘deviant’ behaviour or a health system quality gap?

Discharge against medical advice: ‘deviant’ behaviour or a health system quality gap?

Against Medical Advice Discharges Are Increasing for Targeted Conditions of the Medicare Hospital Readmissions Reduction Program

Discharge against medical advice: Experience from a rural Nigerian hospital

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