readmission rates of patients discharged against medical advice a matched cohort study再次住院的比例的病人出院反对医疗建议匹配的队列研究.pdfVIP

Readmission Rates of Patients Discharged against Medical Advice: A Matched Cohort Study 1 1 2 1,2 Mark Choi , Haerin Kim , Hong Qian , Anita Palepu * 1 Department of Medicine, University of British Columbia, Vancouver BC, Canada, 2 Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, British Columbia, Canada Abstract Objective: We compared the readmission rates and the pattern of readmission among patients discharged against medical advice (AMA) to control patients discharged with approval over a one-year follow-up period. Methods: A retrospective matched-cohort study of 656 patients(328 were discharged AMA) who were followed for one year after their initial hospitalization at an urban university-affiliated teaching hospital in Vancouver, Canada that serves a population with high prevalence of addiction and psychiatric disorders. Multivariate conditional logistic regression was used to examine the independent association of discharge AMA on 14-day related diagnosis hospital readmission. We fit a multivariate conditional negative binomial regression model to examine the readmission frequency ratio between the AMA and non-AMA group. Principal Findings: AMA patients were more likely to be homeless (32.3% vs. 11%) and have co-morbid conditions such as psychiatric illnesses, injection drug use, HIV, hepatitis C and previous gastrointestinal bleeding. Patients discharged AMA were more likely to be readmitted: 25.6% vs. 3.4%, p,0.001 by day 14. The AMA group were more likely to be readmitted within 14 days with a related diagnosis than the non-AMA group (Adjusted Odds Ratio 12.0; 95% Confidence Interval [CI]: 3.7–38.9). Patients who left AMA were more likely to be readmitted multiple times at one year compared