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ABSTRACT: Objectives
To assess the frequency of discharge against medical advice (DAMA) in a large UK teaching hospital, explore factors which increase the risk of DAMA and identify how DAMA impacts patient risk of mortality and readmission.Design
Retrospective cohort study.Setting
Large acute teaching hospital in the UK.Patients
36 683 patients discharged from the acute medical unit of a large UK teaching hospital between 1 January 2012 and 31 December 2016.Measurements
Patients were censored on 1 January 2021. Mortality and 30-day unplanned readmission rates were assessed. Deprivation, age and sex were taken as covariates.Results
3% of patients discharged against medical advice. These patients were younger (median age (years) (IQR)): planned discharge (PD) 59 (40-77); DAMA 39 (28-51), predominantly of male sex (PD 48%; DAMA 66%) and were of greater social deprivation (in three most deprived quintiles PD 69%; DAMA 84%). DAMA was associated with increased risk of death in patients under the age of 33.3 years (adjusted HR 2.6 (1.2-5.8)) and increased incidence of 30-day readmission (standardised incidence ratio 1.9 (1.5-2.2)).Limitations
Readmission to acute hospitals outside of the local health board may have been missed. We were unable to include information regarding comorbidity or severity of presentation.Conclusions
These data highlight the vulnerability of younger patients who DAMA, even in a free-at-the-point-of-delivery healthcare setting.
SUBMITTER: Alagappan A
PROVIDER: S-EPMC10069606 | biostudies-literature | 2023 Mar
REPOSITORIES: biostudies-literature
Alagappan Anand A Chambers Thomas J G TJG Brown Erik E Grecian Sheila M SM Lockman Khalida Ann KA
BMJ open 20230327 3
<h4>Objectives</h4>To assess the frequency of discharge against medical advice (DAMA) in a large UK teaching hospital, explore factors which increase the risk of DAMA and identify how DAMA impacts patient risk of mortality and readmission.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>Large acute teaching hospital in the UK.<h4>Patients</h4>36 683 patients discharged from the acute medical unit of a large UK teaching hospital between 1 January 2012 and 31 December 2016.<h4>Measurement ...[more]