Who Leaves the Hospital Against Medical Advice in the Orthopaedic Setting?

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• 作者：Mariano E. Menendez MD…
• 刊名：Clinical Orthopaedics and Related Research?
• 出版年：2015
• 出版时间：March 2015
• 年：2015
• 卷：473
• 期：3
• 页码：1140-1149
• 全文大小：281 KB
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• 刊物主题：Orthopedics; Surgical Orthopedics; Medicine/Public Health, general; Surgery; Sports Medicine; Conservative Orthopedics;
• 出版者：Springer US
• ISSN：1528-1132

文摘

Background Patients who leave the hospital against medical advice are at risk for readmission and for a variety of complications and are likely to consume more healthcare resources. However, little is known about which factors, if any, may be associated with self-discharge (discharge against medical advice) among orthopaedic inpatients. Questions/purposes We studied the frequency and factors associated with self-discharge in patients hospitalized for orthopaedic trauma and musculoskeletal infection. Methods Using discharge records from the Nationwide Inpatient Sample (2002-011), we identified approximately 7,067,432 patient hospitalizations for orthopaedic trauma and 5,488,686 for musculoskeletal infection. We calculated the proportions of admissions that ended in self-discharge for both trauma and infection patients; then, we examined patient demographics, diagnoses, and hospital factors. Multivariable logistic regression models were constructed to determine independent predictors of self-discharge. Results Approximately one in 333 (0.3%) patients hospitalized for an isolated fracture and one in 47 (2.1%) patients with musculoskeletal infection left against medical advice. Patient characteristics associated with self-discharge included age AIDS/HIV infection (trauma: OR 1.5, 95% CI 1.2-.8, p Conclusions Our data can be used to promptly identify orthopaedic inpatients at higher risk of self-discharge on admission and target interventions to optimize treatment adherence. Strategies to enhance physician communication skills among patients with low health literacy, improve cultural sensitivity, and proactively address substance abuse issues early during hospital admission may aid in preventing discharge dilemmas and merit additional study. Level of Evidence Level III, prognostic study. See the Instructions for Authors for complete description of levels of evidence.