Hospital Patients Discharged Against Medical Advice Face Higher Readmission Rates: Study

Patients who leave the hospital against doctors’ advice are more likely to be readmitted within 30 days, according to the findings of new research.

In a study published this month in the journal JAMA Network Open, Harvard researchers report that those patients who leave the hospital against doctor’s orders are more than twice as likely to experience complications or medical problems that require that they return to a hospital.

Researchers conducted a study involving data from the 2014 National Readmissions Database, which included nearly 20 million hospital admissions for patients 18 years and older discharged between January 2014 and November 2014.

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The data indicates hospital discharge against medical advice was associated with a two-fold increased risk of readmission within 30 days. Patients who left the hospital against doctor’s orders had a 21% increased risk of 30 day all cause readmission. Patients who were discharged following doctor’s orders had only a 12% risk of readmission.

About 19% of patients who left the hospital against doctors’ orders were readmitted to the hospital within the first day after discharge against medical orders. Comparatively, patients who followed doctor’s orders for discharge had a 6% risk of being readmitted within the first day.

Patients who leave the hospital against medical advice are also more likely to be placed in a different hospital when they are readmitted. This may indicate patients are dissatisfied with their initial care at the first hospital, researchers suggested.

The researchers recommend that hospitals with higher discharge against medical advice rates should focus on process of care and how to improve the process for patients.

Furthermore, patients who do leave the hospital against medical advice may be a vulnerable patient population, leading to the increased risk of readmission. Hospitals should focus on how to approach vulnerable patients to decrease the risk of discharge against medical advice and readmission, according to the study’s authors.

However, in contrast, patients who left the hospital early against doctors’ orders had a decreased risk of in-hospital death compared to patients who did not leave against medical advice. In-hospital mortality rates for patients who left against medical advice were 2.5%, compared to 5.6% for patients who did not leave against doctors’ orders.

Readmissions to the hospital after discharge against medical advice accounted for more than 400,000 inpatient hospitalization days leading to an increased total cost of more than $800 million annually.

“Patients leaving against medical advice face higher odds of readmission; hospitals should consider targeted interventions and risk stratification to identify the highest-risk individuals among this vulnerable population,” wrote study authors.

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