Abstract
Background
Although trauma patients are frequently discharged against medical advice (AMA), the
fate of these patients remains mostly unknown.
Methods
Patients with traumatic injuries were identified in the California State Inpatient
Database, 2007 to 2011. Readmission characteristics of patients discharged AMA were
compared with patients discharged home.
Results
There were 203,756 (75.65%) patients discharged home and 4,480 (1.66%) discharged
AMA. Compared with those discharged home, patients discharged AMA had significantly
higher 30-day readmission rates (17.12% vs 6.75%), rates of multiple readmissions
(3.83% vs 1.12%), and likelihood of being readmitted at different hospitals (44.83%
vs 33.82%) (all P < .001). The commonest reasons for readmission in patients discharged AMA were psychiatric
conditions [adjusted odds ratio: 1.67 (1.21 to 2.27)].
Conclusions
Discharge AMA is associated with multiple readmissions and higher rates of readmissions
at different hospitals. Early identification of vulnerable patients and improved modalities
to prevent discharge AMA among these patients may reduce the negative outcomes associated
with discharge AMA among trauma patients.
Keywords
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References
- Increased risk of mortality and readmission among patients discharged against medical advice.Am J Med. 2012; 125: 594-602
- Hospitalized patients with asthma who leave against medical advice: characteristics, reasons, and outcomes.J Allergy Clin Immunol. 2007; 119: 924-929
- Hospital discharge against advice after myocardial infarction: deaths and readmissions.Am J Med. 2007; 120: 1047-1053
- Leaving against medical advice (AMA): risk of 30-day mortality and hospital readmission.J Gen Intern Med. 2010; 25: 926-929
- Care fragmentation in the postdischarge period: surgical readmissions, distance of travel, and postoperative mortality.JAMA Surg. 2015; 150: 59-64
- Rehospitalizations among patients in the Medicare fee-for-service program.N Engl J Med. 2009; 360: 1418-1428
- Who leaves against medical advice?.J Gen Intern Med. 1995; 10: 403-405
- Hospitals as a ‘risk environment’: an ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs.Soc Sci Med. 2014; 105: 59-66
- Factors associated with patients who leave acute-care hospitals against medical advice.Am J Public Health. 2007; 97: 2204-2208
- Readmission rates of patients discharged against medical advice: a matched cohort study.PLoS One. 2011; 6: e24459
- Flow disruptions during trauma care.World J Surg. 2014; 38: 314-321
- Reasons for discharges against medical advice: a qualitative study.Qual Saf Health Care. 2010; 19: 420-424
- Reasons for discharge against medical advice: a case study of emergency departments in Iran.Int J Health Policy Manag. 2013; 1: 137-142
- Who leaves the hospital against medical advice in the orthopaedic setting?.Clin Orthop Relat Res. 2015; 473: 1-10
- Characteristics of patients with acute traumatic brain injury discharged against medical advice in a level 1 urban trauma centre.Brain Inj. 2014; 28: 1288-1294
- Healthcare Cost and Utilization Project Overview. Healthcare Cost and Utilization Project, Rockville, MD2015 (Available at: http://www.hcup-us.ahrq.gov/sidoverview.jsp. Accessed March 20, 2015)
- Hips can lie: impact of excluding isolated hip fractures on external benchmarking of trauma center performance.J Trauma Acute Care Surg. 2010; 69: 1037-1041
- CHARLSON: Stata Module to Calculate Charlson Index of Comorbidity.Boston College, Chestnut Hill, MA2006 ([updated April 2006]; Available at: https://ideas.repec.org/c/boc/bocode/s456719.html. Accessed January 3, 2015)
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- ICDPIC: Stata Module to Provide Methods for Translating International Classification of Diseases (Ninth Revision) Diagnosis Codes into Standard Injury Categories And/or Scores.Boston College, Chestnut Hill, MA2013 ([updated October 2010]; Available at: https://ideas.repec.org/c/boc/bocode/s457028.html. Accessed January 3, 2015)
- Variation in surgical-readmission rates and quality of hospital care.N Engl J Med. 2013; 369: 1134-1142
- What are the true costs of major trauma?.J Trauma Acute Care Surg. 2011; 70: 1086-1095
- A news media analysis of the economic and reputational penalties of the hospital readmissions reduction program.Inquiry. 2014; 51
- Revisiting hospital readmissions.JAMA. 2013; 309: 398-400
- Readmissions Reduction Program 2014.Centers for Medicare & Medicaid Services, Baltimore, MD2014 (Available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html. Accessed February 15, 2015)
- Leaving hospital against medical advice among HIV-positive patients.Can Med Assoc J. 2002; 167: 633-637
- Predictors of medication adherence postdischarge: the impact of patient age, insurance status, and prior adherence.J Hosp Med. 2012; 7: 470-475
- Mental disorders and HIV infection in the emergency department: epidemiology and gender differences.Intern Emerg Med. 2015; 10: 465-469
- Factors associated with trauma clinic follow-up compliance after discharge: experience at an urban level I trauma center.J Trauma Acute Care Surg. 2014; 76: 185-190
- National estimates of predictors of outcomes for emergency general surgery.J Trauma Acute Care Surg. 2015; 78: 482-491
- Frequency and trends of hospital discharges against medical advice (DAMA) in a large administrative database.Ann Ist Super Sanita. 2013; 50: 357-362
- The epidemiology of traumatic brain injury: a review.Epilepsia. 2003; 44: 2-10
- Homicide as a medical outcome: racial disparity in deaths from assault in US level I and II trauma centers.J Trauma Acute Care Surg. 2012; 72: 773-782
- Unplanned return visit to emergency department: a descriptive study from a tertiary care hospital in a low-income country.Eur J Emerg Med. 2011; 18: 276-278
- Improving discharge data fidelity for use in large administrative databases.Neurosurg Focus. 2014; 36: E2
Article info
Publication history
Published online: December 31, 2015
Received in revised form:
November 11,
2015
Received:
May 30,
2015
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
