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Study Reveals Factors Associated With Hospital Discharges Against Doctors’ Advice

Study reveals factors associated with hospital discharges against doctors’ advice

A new study has found that certain factors are linked with a person's decision to leave the hospital against the advice of his or her care provider. The findings, which are published in the Journal of the American Geriatrics Society, may help healthcare providers address this growing problem. Discharge against medical advice is linked with an increased risk of hospital readmission, higher morbidity and mortality, and increased costs. Their analysis, which included more than 29 million hospital stays listed in the 2013 National Inpatient Sample, revealed that >50,000 older adults in the hospital (out of 12 million people under hospital care overall) left the hospital against medical advice that year; however, older men and women were 4 times less likely to do so than people aged 18-64 years. In older adults, race/ethnicity and poverty were more pronounced as risk factors, with older African American individuals at 65% increased risk and low-income older people at 57% increased risk of leaving the hospital against medical advice. "More research is needed to find out why exactly race/ethnicity and poverty are more pronounced as risk factors in older patients, especially since Medicare theoretically offers universal health coverage for patients aged 65 years or older." The investigators noted that the findings are an important first step to additional studies that seek to determine the exact reasons why people may leave the hospital against medical advice and how these reasons differ between older and younger individuals. "The patients' social supports and functional and cognitive abilities were not measured in the original sample. Each of these could influence an older person's ability to leave the hospital against medical advice," said Rosanne Leipzig, MD, PhD, the study team's senior clinician. Article: Discharge Against Medical Advice among Elderly Inpatients in the US, Carlijn Lelieveld, Rosanne Leipzig, Licia Gaber-Bayliss, Madhu Mazumdar, Stavros G. Memtsoudis, Nicole Zubizarreta, and Jashvant Poeran, Journal of the American Geriatrics Society, doi: 10.1111/jgs.14985, published online 19 June 2017.