TY - JOUR
T1 - Increased risk of mortality and readmission among patients discharged against medical advice
AU - Southern, William N.
AU - Nahvi, Shadi
AU - Arnsten, Julia H.
N1 - Funding Information:
Funding: This work was supported by the CTSA Grant UL1 RR025750 and KL2 RR025749 and TL1 RR025748 from the National Center for Research Resources (NCRR) , a component of the National Institutes of Health (NIH) , and the Clinical Investigation Core of the Center for AIDS Research at the Albert Einstein College of Medicine and Montefiore Medical Center, funded by the National Institutes of Health (NIH P30 AI51519 ). Drs Arnsten and Nahvi also were supported by NIH R25 DA023021 .
PY - 2012/6
Y1 - 2012/6
N2 - Background: Approximately 500,000 patients are discharged from US hospitals against medical advice annually, but the associated risks are unknown. Methods: We examined 148,810 discharges from an urban, academic health system between July 1, 2002 and June 30, 2008. Of these, 3544 (2.4%) were discharged against medical advice, and 80,536 (54.1%) were discharged home. We excluded inpatient deaths, transfers to other hospitals or nursing facilities or discharges with home care. Using adjusted and propensity score-matched analyses, we compared 30-day mortality, 30-day readmission, and length of stay between discharges against medical advice and planned discharges. Results: Discharge against medical advice was associated with higher mortality than planned discharge, after adjustment (odds ratio [OR] adj 2.05; 95% confidence interval [CI], 1.48-2.86), and in propensity-matched analysis (OR matched 2.46; 95% CI, 1.29-4.68). Discharge against medical advice also was associated with higher 30-day readmission after adjustment (OR adj 1.84; 95% CI, 1.69-2.01), and in propensity-matched analysis (OR matched 1.65; 95% CI, 1.46-1.87). Finally, discharges against medical advice had shorter lengths of stay than matched planned discharges (3.37 vs 4.16 days, P <.001). Conclusions: Discharge against medical advice is associated with increased risk for mortality and readmission. In addition, discharges against medical advice have shorter lengths of stay than matched planned discharges, suggesting that the increased risks associated with discharge against medical advice are attributable to premature discharge.
AB - Background: Approximately 500,000 patients are discharged from US hospitals against medical advice annually, but the associated risks are unknown. Methods: We examined 148,810 discharges from an urban, academic health system between July 1, 2002 and June 30, 2008. Of these, 3544 (2.4%) were discharged against medical advice, and 80,536 (54.1%) were discharged home. We excluded inpatient deaths, transfers to other hospitals or nursing facilities or discharges with home care. Using adjusted and propensity score-matched analyses, we compared 30-day mortality, 30-day readmission, and length of stay between discharges against medical advice and planned discharges. Results: Discharge against medical advice was associated with higher mortality than planned discharge, after adjustment (odds ratio [OR] adj 2.05; 95% confidence interval [CI], 1.48-2.86), and in propensity-matched analysis (OR matched 2.46; 95% CI, 1.29-4.68). Discharge against medical advice also was associated with higher 30-day readmission after adjustment (OR adj 1.84; 95% CI, 1.69-2.01), and in propensity-matched analysis (OR matched 1.65; 95% CI, 1.46-1.87). Finally, discharges against medical advice had shorter lengths of stay than matched planned discharges (3.37 vs 4.16 days, P <.001). Conclusions: Discharge against medical advice is associated with increased risk for mortality and readmission. In addition, discharges against medical advice have shorter lengths of stay than matched planned discharges, suggesting that the increased risks associated with discharge against medical advice are attributable to premature discharge.
KW - Against medical advice
KW - Hospital medicine
KW - Informed consent
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U2 - 10.1016/j.amjmed.2011.12.017
DO - 10.1016/j.amjmed.2011.12.017
M3 - Article
C2 - 22513194
AN - SCOPUS:84861528944
SN - 0002-9343
VL - 125
SP - 594
EP - 602
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 6
ER -