Journal of general internal medicine · 2010
Leaving against medical advice (AMA): risk of 30-day mortality and hospital readmission.
СтатьяПоддержка NIH: внешняя программаПоддержка правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Glasgow Justin M, Vaughn-Sarrazin Mary, Kaboli Peter J
Аннотация
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, Chi(2) 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.
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, Chi(2) 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.