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Mayo Clin Proc. 2017 Apr;92(4):525-535. doi: 10.1016/j.mayocp.2016.12.022. Epub 2017 Mar 11.

Discharge Against Medical Advice in the United States, 2002-2011.

Author information

1
Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX. Electronic address: Kiara.Spooner@bcm.edu.
2
Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX.

Abstract

OBJECTIVE:

To describe the national frequency, prevalence, and trends of discharge against medical advice (DAMA) among inpatient hospitalizations in the United States and identify differences across patient- and hospital-level characteristics, overall and in clinically distinct diagnostic subgroups.

PATIENTS AND METHODS:

We conducted a retrospective, cross-sectional analysis of inpatient hospitalizations (≥18 years), discharged between January 1, 2002, and December 31, 2011, using the Nationwide Inpatient Sample. Descriptive statistics, multivariable logistic, and joinpoint regression were used for statistical analyses.

RESULTS:

Between January 1, 2002, and December 31, 2011, more than 338,000 inpatient hospitalizations were discharged against medical advice each year, with a 1.9% average annual increase in prevalence over the decade (95% CI, 0.8%-3.0%). Temporal trends in DAMA varied by principal diagnosis. Among patients hospitalized for mental health- or substance abuse-related disorders, there was a -2.3% (95% CI, -3.8% to -0.8%) average annual decrease in the rate of DAMA. A statistically significant temporal rate change was not observed among hospitalizations for pregnancy-related disorders. Multivariable regression revealed several patient and hospital characteristics as predictors of DAMA, including lack of health insurance (odds ratio [OR], 3.78; 95% CI, 3.62-3.94), male sex (OR, 2.40; 95% CI, 2.36-2.45), and northeast region (OR, 1.91; 95% CI, 1.72-2.11). Other predictors included age, race/ethnicity, income, primary diagnosis, severity of illness, and hospital location/type and size.

CONCLUSION:

Rates for DAMA have increased in the United States, and key differences exist across patient and hospital characteristics. Early identification of vulnerable patients and preventive measures such as improved patient-provider communication may reduce DAMA.

PMID:
28291588
DOI:
10.1016/j.mayocp.2016.12.022
[Indexed for MEDLINE]

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