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Discharge Against Medical Advice in Acute Ischemic Stroke: the Risk of 30-Day Unplanned Readmission
Department of Health Statistics, Second Military Medical University, Shanghai, China.
Department of Health Statistics, Second Military Medical University, Shanghai, China; Department of Respiratory and Critical Care Medicine , Jinling Hospital Nanjing University School of Medicine , Nanjing, China.
Department of Health Statistics, Second Military Medical University, Shanghai, China.
Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA.
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2021 (English)In: Journal of general internal medicine, ISSN 0884-8734, E-ISSN 1525-1497, Vol. 36, no 5, p. 1206-1213Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Discharge against medical advice may be associated with more readmissions.

OBJECTIVE: To evaluate DAMA in patients with acute ischemic stroke (AIS) and identify the relationship between DAMA and 30-day unplanned readmissions.

DESIGN: A retrospective cohort study.

PARTICIPANTS: The National Readmission Database was used to identify inpatients with a primary diagnosis of AIS who were either discharged home or DAMA between 2010 and 2017 in the USA.

MEASURES: Demographic features, hospital type, comorbidities, stroke risk factors, severity indices, and treatments were compared between patients discharged routinely and DAMA. Multivariable logistic regression was used to evaluate predictors of DAMA, and a double robust inverse probability of treatment weighting method was used to assess the association between DAMA and 30-day unplanned readmissions.

KEY RESULTS: Overall, 1,335,484 patients with AIS were included, of whom 2.09% (n = 27,892) were DAMA. The prevalence of DAMA in AIS patients increased from 1.65 in 2010 to 2.57% in 2017. The rates of 30-day unplanned readmissions for DAMA and non-DAMA patients were 16.81% and 7.78%, respectively. Patients with drug abuse, alcohol abuse, smoking, prior stroke, psychoses, and intravenous thrombolysis had greater odds of DAMA. DAMA was associated with all-cause readmissions (OR, 2.04; 95% CI, 2.01-2.07) and remained a strong predictor for transient ischemic attack/stroke-specific and cardiac-specific causes of readmissions.

CONCLUSIONS: Although the DAMA rate is low in AIS patients, DAMA is a risk factor for all-cause and recurrent stroke-specific readmissions. Future studies are needed to address issues around compliance and engagement with health care to reduce DAMA.

Place, publisher, year, edition, pages
Springer, 2021. Vol. 36, no 5, p. 1206-1213
Keywords [en]
Acute ischemic stroke, discharge against medical advice, readmission, risk factor
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-89481DOI: 10.1007/s11606-020-06366-0ISI: 000616152000002PubMedID: 33559060Scopus ID: 2-s2.0-85100820331OAI: oai:DiVA.org:oru-89481DiVA, id: diva2:1527152
Note

Funding Agencies:

National Science and Technology Major Project 2017ZX09304030

Dynamic joint model based on multi-source data and its application in prognosis prediction of stroke patients, Natural Science Foundation of Shanghai 19ZR1469800

National Thirteenth Five Year Plan Major Special Project 2017ZX09304016

Three-Year Action Plan for Strengthening Public Health System in Shanghai GWV-10.2-XD05

Available from: 2021-02-10 Created: 2021-02-10 Last updated: 2023-12-08Bibliographically approved

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