Health care education, delivery, and qualityHospitalized patients with asthma who leave against medical advice: Characteristics, reasons, and outcomes
Section snippets
Study site
Wayne State University (WSU) is located in Detroit, Michigan. The Detroit Medical Center (DMC) is a complex of medical facilities affiliated with WSU and is the teaching and clinical research site for WSU School of Medicine. Three large DMC hospitals (Detroit Receiving Hospital, Harper University Hospital, and Sinai-Grace Hospital) were selected for this study to give a more comprehensive representation of patients with asthma. These 3 hospitals serve both the city and the immediate surrounding
Rate of AMA discharge
From 1999 to 2004, there were 6828 asthma discharges, of which 255 (3.7%) left AMA. During the same time period, for all patients above the age of 18 admitted for any nonasthma diagnosis, the aggregate AMA discharge rate was 2.1%. The odds ratio for leaving AMA after an asthma hospitalization compared with a nonasthma hospitalization was 1.86 (95% CI, 1.63-2.11).
To avoid double-counting, we determined that the 3637 unique individuals accounted for the 6828 asthma discharges (Fig 1). Among this
Discussion
Asthma exacerbations are one of the most common reasons for ED visits and hospitalizations in the United States.16, 17 Although the majority of patients will be discharged with approval of the medical team, the findings of this study reveal that a substantial proportion will leave AMA. We also ascertained that patients with asthma who leave AMA are at a much higher risk of relapse over the period of the subsequent month than those who leave with approval.
The overall rate of leaving AMA after an
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Cited by (0)
Supported by the Blue Cross Blue Shield of Michigan Foundation.
Disclosure of potential conflict of interest: A.P. Baptist has received grant support from the Blue Cross Blue Shield of Michigan Foundation and the National Institutes of Health loan repayment program. J. Ager has received grant support from the Blue Cross Blue Shield of Michigan Foundation. The rest of the authors have declared that they have no conflict of interest.