Geha Mental Health Center, 1, Helsinki Street, PO Box 103, 49100 Petach Tikva, Israel.
Eur Psychiatry. 2012 Oct;27(7):496-9. doi: 10.1016/j.eurpsy.2011.04.009. Epub 2011 Jun 25.
To compare the readmission and the mortality rates of schizophrenia patients who were discharged against medical advice (AMA) and patients who were discharged by physician recommendation.
The records (1984-2005) of all consecutive admissions (n=12,937) of schizophrenia patients (n=8,052) were reviewed. Out of this group, 673 (8.3%) refused to remain in the hospital and signed a hospital form for discharge AMA. Their records were analyzed for rates of re-hospitalization and mortality at study closure. The records of AMA patients were compared to those of patients with regular discharge (n=1345).
AMA patients were younger at admission (P<0.001), comprised more males (P<0.01), more were single (P<0.0001), and had a shorter duration of illness than the controls (P<0.05). A total of 49.9% of AMA events occurred within the first 2 weeks of hospitalization. The readmission rate was significantly higher for AMA patients than for the controls (P<0.001). The mortality rate as a result of suicide (P<0.0001) and accidents (P<0.05) was higher for AMA patients compared to controls.
The schizophrenia patients discharged AMA have a higher readmission rate and a higher mortality rate due to suicide and accidents compared to non-AMA discharged patients. Patients with AMA discharge warrant special community surveillance to improve outcome.
比较因拒绝住院而被医生要求出院（AMA）和因医生建议而被出院的精神分裂症患者的再入院率和死亡率。
回顾了所有连续入院（n=12937）的精神分裂症患者（n=8052）的记录（1984-2005 年）。在此组中，有 673 人（8.3%）拒绝留在医院，并签署了 AMA 出院的医院表格。分析了他们的记录，以了解研究结束时的再入院率和死亡率。将 AMA 患者的记录与定期出院的患者（n=1345）的记录进行比较。
AMA 患者入院时年龄较小（P<0.001），男性较多（P<0.01），单身者较多（P<0.0001），且发病时间短于对照组（P<0.05）。在住院的前 2 周内发生了 49.9%的 AMA 事件。与对照组相比，AMA 患者的再入院率显著更高（P<0.001）。与对照组相比，因自杀（P<0.0001）和意外（P<0.05）导致的 AMA 患者死亡率更高。
与非 AMA 出院患者相比，因 AMA 出院的精神分裂症患者的再入院率和因自杀和意外导致的死亡率更高。需要对 AMA 出院的患者进行特殊的社区监测，以改善预后。
