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Discharge against medical advice from hospitalizations for substance use disorders: The potential impact of the Affordable Care Act.
Drug Alcohol Depend. 2019 04 01; 197:115-119.DA

Abstract

OBJECTIVES

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).

METHODS

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.

RESULTS

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.

CONCLUSIONS

As many as 1 in 10 SUD-involved hospitalizations were considered as DAMA. Concerted efforts are needed to enhance insurance benefits for SUDs and patients' knowledge of SUD treatment benefits in order to increase SUD treatment engagement and completion and to reduce DAMA, especially for substance-using patients with Medicaid or opioid use disorder.

Authors+Show Affiliations

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. Electronic address: he.zhu@duke.edu.Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA. Electronic address: litzy.wu@duke.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

30802735

Citation

Zhu, He, and Li-Tzy Wu. "Discharge Against Medical Advice From Hospitalizations for Substance Use Disorders: the Potential Impact of the Affordable Care Act." Drug and Alcohol Dependence, vol. 197, 2019, pp. 115-119.
Zhu H, Wu LT. Discharge against medical advice from hospitalizations for substance use disorders: The potential impact of the Affordable Care Act. Drug Alcohol Depend. 2019;197:115-119.
Zhu, H., & Wu, L. T. (2019). Discharge against medical advice from hospitalizations for substance use disorders: The potential impact of the Affordable Care Act. Drug and Alcohol Dependence, 197, 115-119. https://doi.org/10.1016/j.drugalcdep.2018.12.032
Zhu H, Wu LT. Discharge Against Medical Advice From Hospitalizations for Substance Use Disorders: the Potential Impact of the Affordable Care Act. Drug Alcohol Depend. 2019 04 1;197:115-119. PubMed PMID: 30802735.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Discharge against medical advice from hospitalizations for substance use disorders: The potential impact of the Affordable Care Act. AU - Zhu,He, AU - Wu,Li-Tzy, Y1 - 2019/02/16/ PY - 2018/10/02/received PY - 2018/11/11/revised PY - 2018/12/15/accepted PY - 2019/2/26/pubmed PY - 2019/7/2/medline PY - 2019/2/26/entrez KW - Affordable Care Act KW - Against medical advice KW - Medicaid KW - Substance use disorder KW - Treatment SP - 115 EP - 119 JF - Drug and alcohol dependence JO - Drug Alcohol Depend VL - 197 N2 - OBJECTIVES: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: As many as 1 in 10 SUD-involved hospitalizations were considered as DAMA. Concerted efforts are needed to enhance insurance benefits for SUDs and patients' knowledge of SUD treatment benefits in order to increase SUD treatment engagement and completion and to reduce DAMA, especially for substance-using patients with Medicaid or opioid use disorder. SN - 1879-0046 UR - https://www.unboundmedicine.com/medline/citation/30802735/Discharge_against_medical_advice_from_hospitalizations_for_substance_use_disorders:_The_potential_impact_of_the_Affordable_Care_Act_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0376-8716(18)30659-8 DB - PRIME DP - Unbound Medicine ER -