Discharge against medical advice from hospitalizations for substance use disorders: The potential impact of the Affordable Care Act

Drug and Alcohol Dependence
He Zhu, Li-Tzy Wu

Abstract

To explore whether the Affordable Care Act (ACA) enactment is associated with changes in the proportion of discharge against medical advice (DAMA) among hospitalizations due to substance use disorders (SUDs). Data were drawn from the 2012-2015 National Inpatient Samples. The sample comprised hospitalizations with a principal diagnosis of SUD (i.e., SUD-involved hospitalization) for patients aged 18-64 years (unweighted N = 287,629). Interrupted time series analyses were conducted to evaluate the effect of the ACA on monthly proportions of DAMA among SUD-involved hospitalizations. Overall, approximately 11% of SUD-involved hospitalizations were DAMA. DAMA was most frequently found among hospitalizations for primary opioid use disorder (pre-ACA: 16.4%; post-ACA: 17.2%). Despite the increase in the Medicaid coverage after ACA enactment, there was no significant change in the proportion of DAMA before and after ACA periods across various demographic groups and clinical conditions. Time series analyses also indicated no significant trend effect on the proportion of DAMA during the pre- and post-ACA months. As many as 1 in 10 SUD-involved hospitalizations were considered as DAMA. Concerted efforts are needed to enhance insurance bene...Continue Reading

Citations

Aug 31, 2019·The Psychiatric Quarterly·Amir GarakaniFrank D Buono
Jun 17, 2020·Journal of Addiction Medicine·Charles J SantosJeanmarie Perrone
Mar 17, 2021·Journal for Healthcare Quality : Official Publication of the National Association for Healthcare Quality·David AlfandreEberechukwu Onukwugha

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