Association of Hospital Discharge Against Medical Advice With Readmission and In-Hospital Mortality

JAMA Network Open
Sally Y TanArash Mostaghimi

Abstract

Hospital readmissions contribute to higher expenditures and may sometimes reflect suboptimal patient care. Individuals discharged against medical advice (AMA) are a vulnerable patient population and may have higher risk for readmission. To determine odds of readmission and mortality for patients discharged AMA vs all others, to characterize patient and hospital-level factors associated with readmissions, and to quantify their overall cost burden. Nationally representative, all-payer cohort study using the 2014 National Readmissions Database. Eligible index admissions were nonobstetrical/newborn hospitalizations for patients 18 years and older discharged between January 2014 and November 2014. Admissions were excluded if there was a missing primary diagnosis, discharge disposition, length of stay, or if the patient died during that hospitalization. Data were analyzed between January 2018 and June 2018. Discharge AMA and non-AMA discharge. Thirty-day all-cause readmission and in-hospital mortality rate. There were 19.9 million weighted index admissions, of which 1.5% resulted in an AMA discharge. Within the AMA cohort, 85% were younger than 65 years, 63% were male, 55% had Medicaid or other (including uninsured) coverage, and 39%...Continue Reading

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Mar 11, 2021·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Jena L Welch-ColtraneRobert W Hurley
Nov 17, 2021·Journal of Comparative Effectiveness Research·Eberechukwu OnukwughaDavid Alfandre

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