title: Rate of readmission and mortality risks of schizophrenia patients who were discharged against medical advice.
abstract: OBJECTIVE
  To compare the readmission and the mortality rates of schizophrenia patients who were discharged against medical advice (AMA) and patients who were discharged by physician recommendation.
  
  
  METHODS
  The records (1984-2005) of all consecutive admissions (n=12,937) of schizophrenia patients (n=8,052) were reviewed. Out of this group, 673 (8.3%) refused to remain in the hospital and signed a hospital form for discharge AMA. Their records were analyzed for rates of re-hospitalization and mortality at study closure. The records of AMA patients were compared to those of patients with regular discharge (n=1345).
  
  
  RESULTS
  AMA patients were younger at admission (P<0.001), comprised more males (P<0.01), more were single (P<0.0001), and had a shorter duration of illness than the controls (P<0.05). A total of 49.9% of AMA events occurred within the first 2 weeks of hospitalization. The readmission rate was significantly higher for AMA patients than for the controls (P<0.001). The mortality rate as a result of suicide (P<0.0001) and accidents (P<0.05) was higher for AMA patients compared to controls.
  
  
  CONCLUSIONS
  The schizophrenia patients discharged AMA have a higher readmission rate and a higher mortality rate due to suicide and accidents compared to non-AMA discharged patients. Patients with AMA discharge warrant special community surveillance to improve outcome.
authors.affiliation: Geha Mental Health Center, 1, Helsinki Street, PO Box 103, 49100 Petach Tikva, Israel. valevski@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Valevski
authors.forename: G
authors.initials: G
authors.lastname: Zalsman
authors.forename: S
authors.initials: S
authors.lastname: Tsafrir
authors.forename: R
authors.initials: R
authors.lastname: Lipschitz-Elhawi
authors.forename: A
authors.initials: A
authors.lastname: Weizman
authors.forename: T
authors.initials: T
authors.lastname: Shohat
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012306:Risk; D012559:Schizophrenia / Q000401:mortality* / Q000628:therapy*; D012737:Sex Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data*