Abstract
Background: A discharge against medical advice (AMA) after an asthma hospitalization is a frustrating problem for health care providers, yet little is known about this occurrence. Objective: To determine the baseline characteristics, reasons for leaving, and clinical outcomes of patients with asthma who leave AMA. Methods: A retrospective study from 1999 to 2004 of all asthma discharges from 3 large hospitals in Detroit compared those who left AMA with those who left with medical approval. Results: There were 180 patients who left AMA and 3457 patients who had a standard discharge. Patients with asthma who left AMA were more likely to be younger, male, have Medicaid or lack insurance, require intensive care unit admission, and have a lower socioeconomic status than patients with asthma discharged with approval (P < .05 for all comparisons). There was no difference in race, day of the week admitted, or month admitted. Among records that documented a reason for leaving AMA, the most common was dissatisfaction with care, although a variety of motives were found. Finally, patients who left AMA were more likely to have an asthma relapse within 30 days. This included both emergency department revisits (21.7% vs 5.4%; P < .001) and readmission to the hospital (8.5% vs 3.2%; P < .001). Conclusion: Patients with asthma who leave AMA have demographic and hospital admission characteristics that differ from those who leave with approval. The reasons why patients with asthma leave AMA are varied. Within 30 days, patients with asthma who leave AMA have much higher readmission and emergency department return rates. Clinical implications: Patients with asthma who leave AMA are at increased risk of relapse.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 924-929 |
| Number of pages | 6 |
| Journal | Journal of Allergy and Clinical Immunology |
| Volume | 119 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 2007 |
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Keywords
- against medical advice
- Asthma
- health
- insurance
- patient discharge
- patient readmission
- relapse, recurrence
- socioeconomic status
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology
Cite this
Hospitalized patients with asthma who leave against medical advice : Characteristics, reasons, and outcomes. / Baptist, Alan P.; Warrier, Indulekha; Arora, Rachna; Ager, Joel; Massanari, R. Michael.
In: Journal of Allergy and Clinical Immunology, Vol. 119, No. 4, 04.2007, p. 924-929.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Hospitalized patients with asthma who leave against medical advice
T2 - Characteristics, reasons, and outcomes
AU - Baptist, Alan P.
AU - Warrier, Indulekha
AU - Arora, Rachna
AU - Ager, Joel
AU - Massanari, R. Michael
PY - 2007/4
Y1 - 2007/4
N2 - Background: A discharge against medical advice (AMA) after an asthma hospitalization is a frustrating problem for health care providers, yet little is known about this occurrence. Objective: To determine the baseline characteristics, reasons for leaving, and clinical outcomes of patients with asthma who leave AMA. Methods: A retrospective study from 1999 to 2004 of all asthma discharges from 3 large hospitals in Detroit compared those who left AMA with those who left with medical approval. Results: There were 180 patients who left AMA and 3457 patients who had a standard discharge. Patients with asthma who left AMA were more likely to be younger, male, have Medicaid or lack insurance, require intensive care unit admission, and have a lower socioeconomic status than patients with asthma discharged with approval (P < .05 for all comparisons). There was no difference in race, day of the week admitted, or month admitted. Among records that documented a reason for leaving AMA, the most common was dissatisfaction with care, although a variety of motives were found. Finally, patients who left AMA were more likely to have an asthma relapse within 30 days. This included both emergency department revisits (21.7% vs 5.4%; P < .001) and readmission to the hospital (8.5% vs 3.2%; P < .001). Conclusion: Patients with asthma who leave AMA have demographic and hospital admission characteristics that differ from those who leave with approval. The reasons why patients with asthma leave AMA are varied. Within 30 days, patients with asthma who leave AMA have much higher readmission and emergency department return rates. Clinical implications: Patients with asthma who leave AMA are at increased risk of relapse.
AB - Background: A discharge against medical advice (AMA) after an asthma hospitalization is a frustrating problem for health care providers, yet little is known about this occurrence. Objective: To determine the baseline characteristics, reasons for leaving, and clinical outcomes of patients with asthma who leave AMA. Methods: A retrospective study from 1999 to 2004 of all asthma discharges from 3 large hospitals in Detroit compared those who left AMA with those who left with medical approval. Results: There were 180 patients who left AMA and 3457 patients who had a standard discharge. Patients with asthma who left AMA were more likely to be younger, male, have Medicaid or lack insurance, require intensive care unit admission, and have a lower socioeconomic status than patients with asthma discharged with approval (P < .05 for all comparisons). There was no difference in race, day of the week admitted, or month admitted. Among records that documented a reason for leaving AMA, the most common was dissatisfaction with care, although a variety of motives were found. Finally, patients who left AMA were more likely to have an asthma relapse within 30 days. This included both emergency department revisits (21.7% vs 5.4%; P < .001) and readmission to the hospital (8.5% vs 3.2%; P < .001). Conclusion: Patients with asthma who leave AMA have demographic and hospital admission characteristics that differ from those who leave with approval. The reasons why patients with asthma leave AMA are varied. Within 30 days, patients with asthma who leave AMA have much higher readmission and emergency department return rates. Clinical implications: Patients with asthma who leave AMA are at increased risk of relapse.
KW - against medical advice
KW - Asthma
KW - health
KW - insurance
KW - patient discharge
KW - patient readmission
KW - relapse, recurrence
KW - socioeconomic status
UR - http://www.scopus.com/inward/record.url?scp=34047180462&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34047180462&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2006.11.695
DO - 10.1016/j.jaci.2006.11.695
M3 - Article
C2 - 17239431
AN - SCOPUS:34047180462
VL - 119
SP - 924
EP - 929
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
SN - 0091-6749
IS - 4
ER -