住院患者出院时未经医嘱离院率、原因及再入院风险预测因素的回顾性队列研究——来自一家三甲医院。
Leaving Against Medical Advice From In-patients Departments Rate, Reasons and Predicting Risk Factors for Re-visiting Hospital Retrospective Cohort From a Tertiary Care Hospital.
机构信息
Orthopedic Section, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
General Surgery Department, York Hospital, York, PA, USA.
出版信息
Int J Health Policy Manag. 2019 Aug 1;8(8):474-479. doi: 10.15171/ijhpm.2019.26.
BACKGROUND
Approximately 1% to 2% of hospitalized patients get discharged or leave from the hospital against medical advice and up to 26% in some centers. They have higher readmission rate and risk of complications than patients who receive complete care. In this study we aimed to determine the rate of leave against medical advice (LAMA) and reasons for the same across different in-patient departments of a tertiary care hospital.
METHODS
Retrospective cohort study on patients admitted in all departments at our institute over a 1-year period. All patients who were admitted to an in-patient ward at the hospital and who left against medical advice by submitting a duly filled LAMA form were included. Univariate and multivariate logistic regression models with forward selection methods were employed. Revisit to hospital within 30 days; to clinic or emergency department was outcome variable for regression.
RESULTS
From June 2015 to May 2016 there were 429 LAMA patients, accounting for 0.7% of total admissions. Females were 223 (52%) compared to males 206 (48%). Finances were quoted as the most common reason for LAMA by 174 (41%) patients followed by domestic problems 78 (18%). Internal medicine was the service with the highest number of LAMA patients ie, 153 (36%) followed by Pediatric medicine with 73 (17%). Of the 429 patients, 147 (34%) patients revisited the hospital within 30 days. Sixty-one percent of these 'bounced-back' LAMA patients had worsening or persistence of same problem, or new problem/s had developed. In unadjusted bivariate logistic model, patients who were advised for follow-up during discharge against medical advice were four times more likely to revisit the hospital. Patients who were married had an increased odd of revisiting the hospital.
CONCLUSION
Financial reasons are the most common stated reasons to LAMA. Patients who LAMA are at a high risk of clinical worsening and 'bouncing back.' This is the first study from our region on in-patient LAMA rates, to our knowledge. The results can be used for planning measures to reduce LAMA rates and its consequences.
背景
约有 1%至 2%的住院患者未经医嘱出院或离开医院，在某些中心甚至高达 26%。与接受完整治疗的患者相比，他们的再入院率和并发症风险更高。在这项研究中，我们旨在确定一家三级保健医院不同住院病房中未经医嘱出院（LAMA）的发生率和原因。
方法
对我院所有科室住院患者进行回顾性队列研究。所有在我院住院并填写正式 LAMA 表要求出院的患者均被纳入研究。采用向前选择法的单变量和多变量逻辑回归模型。30 天内再次就诊于医院、门诊或急诊是回归的因变量。
结果
2015 年 6 月至 2016 年 5 月期间，有 429 名 LAMA 患者，占总入院人数的 0.7%。女性 223 人（52%），男性 206 人（48%）。174 名（41%）患者将经济问题列为 LAMA 的最常见原因，其次是 78 名（18%）患者将家庭问题列为 LAMA 的最常见原因。内科是 LAMA 患者人数最多的科室，有 153 人（36%），其次是儿科有 73 人（17%）。在 429 名患者中，有 147 名（34%）患者在 30 天内再次就诊。其中 61%的“反弹”LAMA 患者出现或持续存在相同的问题，或出现新的问题。在未调整的单变量逻辑模型中，在出院时被建议随访的患者再次就诊的可能性是未被建议随访的患者的四倍。已婚患者再次就诊的可能性增加。
结论
经济原因是 LAMA 最常见的原因。未经医嘱出院的患者有很高的临床恶化和“反弹”风险。据我们所知，这是我们地区第一份关于住院 LAMA 发生率的研究。研究结果可用于制定减少 LAMA 发生率及其后果的措施。
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