Journal article
Leaving Against Medical Advice (AMA): Risk of 30-Day Mortality and Hospital Readmission
Journal of general internal medicine : JGIM, Vol.25(9), pp.926-929
09/2010
DOI: 10.1007/s11606-010-1371-4
PMCID: PMC2917668
PMID: 20425146
Abstract
Background
With 1–2% of patients leaving the hospital against medical advice (AMA), the potential for these patients to suffer adverse health outcomes is of major concern.
Objective
To examine 30-day hospital readmission and mortality rates for medical patients who left the hospital AMA and identify independent risk factors associated with these outcomes.
Design
A 5-year retrospective cohort of all patients discharged from a Veterans Administration (VA) hospital.
Subjects
The final study sample included 1,930,947 medical admissions to 129 VA hospitals from 2004 to 2008; 32,819 patients (1.70%) were discharged AMA.
Measurements
Primary outcomes of interest were 30-day mortality and 30-day all-cause hospital readmission.
Results
Compared to discharges home, AMA patients were more likely to be black, have low income, and have co-morbid alcohol abuse (for all, Χ2 df = 1, p < 0.001). AMA patients had a higher 30-day readmission rate (17.7% vs. 11.0%, p < 0.001) and higher 30-day mortality rate (0.75% vs. 0.61%, p = 0.001). In Cox proportional hazard modeling controlling for demographics and co-morbidity, the largest hazard for patients having a 30-day readmission is leaving AMA (HR = 1.35, 95% CI 1.32–1.39). Similar modeling for 30-day mortality reveals a nearly significant increased hazard rate for patients discharged AMA (HR = 1.10, 95% CI 0.98–1.24).
Conclusions
Due to the higher risk of adverse outcomes, hospitals should target AMA patients for post-discharge interventions, such as phone follow-up, home visits, or mental health counseling to improve outcomes.
Details
- Title: Subtitle
- Leaving Against Medical Advice (AMA): Risk of 30-Day Mortality and Hospital Readmission
- Creators
- Justin M Glasgow - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the Iowa City VA Medical Center, 601 Highway 6 West, Mailstop 152, Iowa, IA 52246-2208 USAMary Vaughan-Sarrazin - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the Iowa City VA Medical Center, 601 Highway 6 West, Mailstop 152, Iowa, IA 52246-2208 USAPeter J Kaboli - The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the Iowa City VA Medical Center, 601 Highway 6 West, Mailstop 152, Iowa, IA 52246-2208 USA
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.25(9), pp.926-929
- Publisher
- Springer-Verlag; New York
- DOI
- 10.1007/s11606-010-1371-4
- PMID
- 20425146
- PMCID
- PMC2917668
- ISSN
- 0884-8734
- eISSN
- 1525-1497
- Language
- English
- Date published
- 09/2010
- Academic Unit
- Health Management and Policy; Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984063133802771
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