Increased risk of mortality and readmission among patients discharged against medical advice

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)594-602
Number of pages9
JournalAmerican Journal of Medicine
Volume125
Issue number6
DOIs
StatePublished - Jun 2012

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Patient Readmission
Odds Ratio
Confidence Intervals
Length of Stay
Mortality
Urban Health
Propensity Score
Home Care Services
Inpatients
Nursing

Keywords

  • Against medical advice
  • Hospital medicine
  • Informed consent

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Increased risk of mortality and readmission among patients discharged against medical advice",
abstract = "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.",
keywords = "Against medical advice, Hospital medicine, Informed consent",
author = "Southern, {William N.} and Shadi Nahvi and Arnsten, {Julia H.}",
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T1 - Increased risk of mortality and readmission among patients discharged against medical advice

AU - Southern, William N.

AU - Nahvi, Shadi

AU - Arnsten, Julia H.

PY - 2012/6

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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.

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