Readmissions after unauthorized discharges in the cardiovascular setting

Area of Science:

• Cardiovascular Medicine
• Health Services Research
• Patient Safety

Background:

• Patients discharged against medical advice (AMA) may face increased hospital readmission risks.
• Premature unauthorized discharges can exacerbate these risks.

Purpose of the Study:

• To investigate the association between AMA discharges and cardiovascular disease (CVD) hospital readmissions.
• To mitigate potential confounding, selection bias, and hospital clustering effects.

Main Methods:

• Cross-sectional study utilizing hospital discharge data (2000-2005).
• Examined 7-day, 31-day, and 180-day CVD-related readmissions following index CVD discharges.
• Employed multivariate models with adjustments for clustering and selection bias.

Main Results:

• AMA discharges were linked to higher readmission rates: 2.2% (7-day), 6% (31-day), and 14% (180-day).
• Adjusted odds of CVD readmission were significantly elevated for AMA patients: 154% (7-day), 51% (31-day), and 19% (180-day).
• Findings remained robust after analyzing readmissions to any hospital and using propensity score analysis.

Conclusions:

• Discharge against medical advice for CVD patients predicts subsequent CVD-related readmissions.
• The association between AMA discharge and readmission is strongest within the initial week post-discharge.