title: Rates of readmission and death associated with leaving hospital against medical advice: a population-based study.
abstract: BACKGROUND
  Leaving hospital against medical advice may have adverse consequences. Previous studies have been limited by evaluating specific types of patients, small sample sizes and incomplete determination of outcomes. We hypothesized that leaving hospital against medical advice would be associated with increases in subsequent readmission and death.
  
  
  METHODS
  In a population-based analysis involving all adults admitted to hospital and discharged alive in Manitoba from Apr. 1, 1990, to Feb. 28, 2009, we evaluated all-cause 90-day mortality and 30-day hospital readmission. We used multivariable regression, adjusted for age, sex, socioeconomic status, year of hospital admission, patient comorbidities, hospital diagnosis, past frequency of admission to hospital, having previously left hospital against medical advice and data clustering (patients with multiple admissions). For readmission, we assessed both between-person and within-person effects of leaving hospital against medical advice.
  
  
  RESULTS
  Leaving against medical advice occurred in 21 417 of 1 916 104 index hospital admissions (1.1%), and was associated with higher adjusted rates of 90-day mortality (odds ratio [OR] 2.51, 95% confidence interval [CI] 2.18-2.89), and 30-day hospital readmission (within-person OR 2.10, CI 1.99-2.21; between-person OR 3.04, CI 2.79-3.30). In our additional analyses, elevated rates of readmission and death associated with leaving against medical advice were manifest within 1 week and persisted for at least 180 days after discharge.
  
  
  CONCLUSIONS
  Adults who left the hospital against medical advice had higher rates of hospital readmission and death. The persistence of these effects suggests that they are not solely a result of incomplete treatment of acute illness. Interventions aimed at reducing these effects may need to include longitudinal interventions extending beyond admission to hospital.
authors: Allan
authors: A
authors: Garland
authors: Clare D
authors: CD
authors: Ramsey
authors: Randy
authors: R
authors: Fransoo
authors: Kendiss
authors: K
authors: Olafson
authors: Daniel
authors: D
authors: Chateau
authors: Marina
authors: M
authors: Yogendran
authors: Allen
authors: A
authors: Kraut
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D009026:Mortality; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors
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