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Discharge Against Medical Advice in the United States, 2002-2011.
Mayo Clin Proc. 2017 04; 92(4):525-535.MC

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.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

28291588

Citation

Spooner, Kiara K., et al. "Discharge Against Medical Advice in the United States, 2002-2011." Mayo Clinic Proceedings, vol. 92, no. 4, 2017, pp. 525-535.
Spooner KK, Salemi JL, Salihu HM, et al. Discharge Against Medical Advice in the United States, 2002-2011. Mayo Clin Proc. 2017;92(4):525-535.
Spooner, K. K., Salemi, J. L., Salihu, H. M., & Zoorob, R. J. (2017). Discharge Against Medical Advice in the United States, 2002-2011. Mayo Clinic Proceedings, 92(4), 525-535. https://doi.org/10.1016/j.mayocp.2016.12.022
Spooner KK, et al. Discharge Against Medical Advice in the United States, 2002-2011. Mayo Clin Proc. 2017;92(4):525-535. PubMed PMID: 28291588.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Discharge Against Medical Advice in the United States, 2002-2011. AU - Spooner,Kiara K, AU - Salemi,Jason L, AU - Salihu,Hamisu M, AU - Zoorob,Roger J, Y1 - 2017/03/11/ PY - 2016/09/23/received PY - 2016/11/30/revised PY - 2016/12/14/accepted PY - 2017/3/16/pubmed PY - 2017/6/6/medline PY - 2017/3/15/entrez SP - 525 EP - 535 JF - Mayo Clinic proceedings JO - Mayo Clin Proc VL - 92 IS - 4 N2 - 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. SN - 1942-5546 UR - https://www.unboundmedicine.com/medline/citation/28291588/Discharge_Against_Medical_Advice_in_the_United_States_2002_2011_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0025-6196(17)30073-3 DB - PRIME DP - Unbound Medicine ER -