ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2013
Rates of readmission and death associated with leaving hospital against medical advice: a population-based study.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers.
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42 citing papers in PubMed.
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- Comparative Effectiveness of Long-Acting Lipoglycopeptides vs Standard-of-Care Antibiotics in Serious Bacterial Infections.JAMA network open · 2025Article
- The experiences of patients who leave hospital against medical advice: analysis of survey data.Frontiers in health services · 2025Article
- Addressing Colorectal Cancer Disparities in Unhoused Populations: A Call for Equitable Access and Compassionate Care.Clinics in colon and rectal surgery · 2025Review
- Quantitative Analysis of Characteristics Associated with Patient-Directed Discharges, Representations, and Readmissions: a Safety-Net Hospital Experience.Journal of general internal medicine · 2024Article
- Self-discharge during treatment for acute recreational drug toxicity: an observational study from emergency departments in seven European countries.International journal of emergency medicine · 2023Article
- Rates, Reasons, and Independent Predictors of Readmissions in Portal Venous Thrombosis Hospitalizations in the USA.Gastroenterology research · 2022Article
- "I have such a hard time hitting myself, I thought it'd be easier": perspectives of hospitalized patients on injecting drugs into vascular access devices.Harm reduction journal · 2022Article
- Clinical Outcomes and Predictors of Thirty-Day Readmissions of Hypertriglyceridemia-Induced Acute Pancreatitis.Gastroenterology research · 2022Article
- First Nations' hospital readmission ending in death: a potential sentinel indicator of inequity?International journal of circumpolar health · 2021Article
- Factors Associated with Readmission Among General Internal Medicine Patients Experiencing Homelessness.Journal of general internal medicine · 2021Observational
- Hospital admissions and mortality due to complications of injection drug use in two hospitals in Regina, Canada: retrospective chart review.Harm reduction journal · 2021Article
- Chronic Pancreatitis Patients Who Leave Against Medical Advice: Prevalence, Trend, and Predictors.Digestive diseases and sciences · 2021Article
- Implementation of a Provider in Triage and Its Effect on Left without Being Seen Rate at a Community Trauma Center.Open access emergency medicine : OAEM · 2021Article
- Healthcare Resource Utilization Following a Discharge Against Medical Advice: An Analysis of Commercially Insured Adults.Journal of hospital medicine · 2020Article
- Discharge against medical advice among neurological patients: Characteristics and outcomes.Health services research · 2020Article
- Association of Hospital Discharge Against Medical Advice With Readmission and In-Hospital Mortality.JAMA network open · 2020Article
- Presenting complaints and mortality in a cohort of 22 000 adult emergency patients at a local hospital in Nepal.Journal of global health · 2019Observational
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No grant is acknowledged in the PubMed record.
Abstract
backgroundLeaving 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.
methodsIn 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.
resultsLeaving 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.
interpretationAdults 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.
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