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违背儿童医院的医疗建议离开
Jeffrey I Campbell1,2, Destiny G Tolliver3,2, Yuan He4
1Section of Pediatric Infectious Diseases.
Pediatrics
|October 9, 2024
概括
违背医疗建议 (AMA) 离开医院发生在0.08%的儿科接触中. 非西班牙裔黑人儿童离开AMA的几率更高,这与再接收风险增加有关.
科学领域:
- 儿科健康服务研究 儿童健康服务研究
- 在住院护理中的健康公平.
- 患者出院研究 患者出院研究
背景情况:
- 违背医疗建议 (AMA) 离开医院意味着儿科住院病人的家庭-临床医生关系的关键崩.
- 在儿科护理中,AMA的出院引起了伦理困境.
- 缺乏关于美国儿童医院AMA出院的频率和特征的国家数据.
研究的目的:
- 确定违背医疗建议 (AMA) 离开医院的儿童的全国频率和特征.
- 确定与儿科患者AMA出院相关的人口,地理和临床因素.
- 检查AMA出院和儿童随后的再入院之间的关联.
主要方法:
- 一项回顾性队列研究分析了从2018年到2022年间在43家美国儿童医院的18岁以下儿童的3,672,243次住院接触.
- 数据来源于儿科健康信息系统 (PHIS) 数据库.
- 多变量混合效应后勤回归模型评估了与离开AMA和14天全因再入院相关的因素.
主要成果:
- 大约0.08% (2,972/3,672,243) 的儿科住院患者遭遇导致离开AMA.
- 与非西班牙裔白人患者相比,非西班牙裔黑人患者离开AMA的几率更高 (aOR 1.31).
- 拥有非商业保险的患者有更高的AMA出院几率,这与14天再入院风险增加有关 (aOR 1.41).
- 在AMA出院率中观察到显著的医院间变化.
结论:
- 违背医疗建议 (AMA) 离开医院发生在约1235例儿科住院患者中的1例中.
- 非西班牙裔黑人儿童面临AMA出院的可能性增加.
- AMA出院与14天再入院的可能性显著增加.
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