Increased Mortality and Readmission among Patients Discharged Against Medical Advice

1Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
2Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
3Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 136

Background:

Approximately 500,000 patients are discharged from U.S. hospitals against medical advice (AMA) each year. The clinical implications of discharge AMA are not known. We hypothesized that discharge AMA would be associated with a strong and significantly increased risk for mortality and readmission in a general medical inpatient population.

Methods:

We used a propensity‐score‐matched retrospective cohort study design to compare the 30–day mortality and 30‐day readmission of discharges AMA with planned discharges. We examined data from all admissions (n = 148.810) to the inpaBent medical services of an urban, academic health system from July 1, 2002, to June 30, 2008. We compared all discharges home AMA (n = 3554) with propensity‐score‐matched planned discharges home (n = 3554), The propensity score model included demographic characteristics, laboratory values, comorbidifes, and discharge diagnoses, The main outcome measures, 30‐day mortality and 30‐day readmission were compared using Kaplan‐Meier methods and log‐rank tests. Mixed‐effects random intercept logistic regression models were constructed to assess the independent impact of discharge AMA on outcomes, after adjustment for demographic and clinical characteristics.

Results:

Of 148,810 discharges, 3,544 (2.4%) were discharged AMA. AMA and planned discharges (matched controls) were similar with respect to demographic and clinical characteristics. Discharge AMA was associated with significantly increased mortality (45 vs. 27, P = 0.03). The increased mortality associated with discharge AMA remained strong and significant after adjustment for demographic and clinical characteristics (OR adjusted = 2.33, 95% Cl: 1.05‐5.15). The increased mortality associated with discharge AMA was seen in all subgroups but was most pronounced in patients older than age 65 (OR = 2.94, 95% Cl: 0.72‐12.00), patients with HIV (OR 3.75,95% Cl: 0.72‐19.51), and patients with greater comorbidity (OR 2.34,95% Cl: 1.05‐5.18). Discharge AMA was associated with increased readmission (877 vs. 575, P < 0.001). After adjustment, the association between discharge AMA and read mission remained strong and significant (OR adjusted 1.77; 95% Cl 1.52‐2.05).

Conclusions:

Discharge AMA may increase the risk of mortality and readmission. This risk should be explained to patients, and discharge AMA should be avoided.

Author Disclosure:

W. Southern, none; S. Nahvi, none; J. Arnsten, none.

To cite this abstract:

Southern W, Nahvi S, Arnsten J. Increased Mortality and Readmission among Patients Discharged Against Medical Advice. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 136. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/increased-mortality-and-readmission-among-patients-discharged-against-medical-advice/. Accessed March 20, 2019.

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