Tawk Rima, Dutton Matthew
Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, USA.
Int J Environ Res Public Health. 2015 Dec 31;13(1):95. doi: 10.3390/ijerph13010095.
There is a paucity of published literature on the length of hospital stays (LOS) for patients who leave against medical advice (AMA) and on the factors that predict their LOS. The purpose of the study is to examine the relationship between race and the LOS for AMA patients after adjusting for patient and hospital characteristics. National Hospital Discharge Survey (NHDS) data were used to describe LOS for AMA patients aged 18 years or older. Patient characteristics included age, sex, race, marital status, insurance, and diagnosis (ICD-9-CM). Hospital characteristics consisted of ownership, region and bed size. LOS was the major outcome measure. Using data from all years 1988-2006, the expected time to AMA discharge was first examined as a function of race, then adjusting for year terms, patient and hospital characteristics, and major medical diagnoses and mental illness. The unadjusted effect of race on the expected time of leaving AMA was about twice the adjusted effect. After controlling for the other covariates, the expected time to AMA discharge is 20% shorter for Blacks than Whites. The most significant predictors included age, insurance coverage, mental illness, gender, and region. Factors identified in this study offer insights into directions for evidence based- health policy to reduce AMA discharges.
关于擅自离院（AMA）患者的住院时长（LOS）以及预测其住院时长的因素，已发表的文献较少。本研究的目的是在对患者和医院特征进行调整后，考察种族与AMA患者住院时长之间的关系。利用国家医院出院调查（NHDS）数据来描述18岁及以上AMA患者的住院时长。患者特征包括年龄、性别、种族、婚姻状况、保险和诊断（ICD - 9 - CM）。医院特征包括所有权、地区和床位规模。住院时长是主要的结局指标。利用1988 - 2006年所有年份的数据，首先将擅自离院出院的预期时间作为种族的函数进行考察，然后对年份因素、患者和医院特征以及主要医疗诊断和精神疾病进行调整。种族对擅自离院预期时间的未调整效应约为调整后效应的两倍。在控制了其他协变量后，黑人擅自离院出院的预期时间比白人短20%。最显著的预测因素包括年龄、保险覆盖、精神疾病、性别和地区。本研究中确定的因素为基于证据的卫生政策减少擅自离院提供了方向。
