Readmission Rates of Patients Discharged Against Medical Advice
Author Information
Author(s): Mark Choi, Haerin Kim, Hong Qian, Anita Palepu
Primary Institution: University of British Columbia
Hypothesis
The rate of hospital readmission would be higher than reported in previous studies given the high prevalence of addiction disorders in our patient population and their increased risk of discharges AMA.
Conclusion
Patients discharged AMA had higher readmission rates, were predisposed to multiple readmissions, and had a higher in-hospital mortality.
Supporting Evidence
- Patients discharged AMA were more likely to be homeless (32.3% vs. 11%).
- 25.6% of AMA patients were readmitted within 14 days compared to 3.4% of non-AMA patients.
- Patients who left AMA had a higher all-cause in-hospital mortality during the 12-month follow-up (6.7% vs. 2.4%).
- Patients discharged AMA had a median of 4 co-morbidities compared to 2 in the non-AMA group.
- 54% of AMA patients had a history of injection drug use compared to 23% in the non-AMA group.
Takeaway
Patients who leave the hospital against medical advice are more likely to come back to the hospital and have serious health problems.
Methodology
A retrospective matched-cohort study comparing 328 patients discharged AMA to matched controls over a one-year follow-up period.
Potential Biases
Potential bias due to the single-site nature of the study and lack of tracking for other healthcare interactions.
Limitations
Results may not be generalizable to all hospitals and did not track patient admissions to other hospitals or deaths outside the hospital.
Participant Demographics
Patients were primarily from a population with high prevalence of addiction and psychiatric disorders, with 32.3% being homeless.
Statistical Information
P-Value
p<0.001
Confidence Interval
95% CI: 3.7–38.9
Statistical Significance
p<0.001
Digital Object Identifier (DOI)
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