Department of Health Statistics, Second Military Medical University, Shanghai, China.
Department of Respiratory and Critical Care Medicine , Jinling Hospital Nanjing University School of Medicine , 210002, Nanjing, China.
J Gen Intern Med. 2021 May;36(5):1206-1213. doi: 10.1007/s11606-020-06366-0. Epub 2021 Feb 8.
Discharge against medical advice may be associated with more readmissions.
To evaluate DAMA in patients with acute ischemic stroke (AIS) and identify the relationship between DAMA and 30-day unplanned readmissions.
A retrospective cohort study.
The National Readmission Database was used to identify inpatients with a primary diagnosis of AIS who were either discharged home or DAMA between 2010 and 2017 in the USA.
Demographic features, hospital type, comorbidities, stroke risk factors, severity indices, and treatments were compared between patients discharged routinely and DAMA. Multivariable logistic regression was used to evaluate predictors of DAMA, and a double robust inverse probability of treatment weighting method was used to assess the association between DAMA and 30-day unplanned readmissions.
Overall, 1,335,484 patients with AIS were included, of whom 2.09% (n = 27,892) were DAMA. The prevalence of DAMA in AIS patients increased from 1.65 in 2010 to 2.57% in 2017. The rates of 30-day unplanned readmissions for DAMA and non-DAMA patients were 16.81% and 7.78%, respectively. Patients with drug abuse, alcohol abuse, smoking, prior stroke, psychoses, and intravenous thrombolysis had greater odds of DAMA. DAMA was associated with all-cause readmissions (OR, 2.04; 95% CI, 2.01-2.07) and remained a strong predictor for transient ischemic attack/stroke-specific and cardiac-specific causes of readmissions.
Although the DAMA rate is low in AIS patients, DAMA is a risk factor for all-cause and recurrent stroke-specific readmissions. Future studies are needed to address issues around compliance and engagement with health care to reduce DAMA.
违反医嘱出院可能与更多的再入院有关。
评估急性缺血性脑卒中（AIS）患者中的 DAMA，并确定 DAMA 与 30 天非计划性再入院之间的关系。
回顾性队列研究。
使用国家再入院数据库，在美国 2010 年至 2017 年间，确定患有 AIS 且主要诊断为 AIS 的住院患者，他们要么常规出院，要么 DAMA。
比较常规出院和 DAMA 患者的人口统计学特征、医院类型、合并症、中风危险因素、严重程度指数和治疗方法。多变量逻辑回归用于评估 DAMA 的预测因素，并用双重稳健逆概率处理加权方法评估 DAMA 与 30 天非计划性再入院之间的关系。
共纳入 1335484 例 AIS 患者，其中 2.09%（n=27892）为 DAMA。AIS 患者中 DAMA 的比例从 2010 年的 1.65%增加到 2017 年的 2.57%。DAMA 和非 DAMA 患者的 30 天非计划性再入院率分别为 16.81%和 7.78%。药物滥用、酒精滥用、吸烟、既往中风、精神病和静脉溶栓患者更有可能 DAMA。DAMA 与全因再入院相关（OR，2.04；95%CI，2.01-2.07），并且仍然是短暂性脑缺血发作/中风特异性和心脏特异性再入院的强有力预测因素。
尽管 AIS 患者中的 DAMA 率较低，但 DAMA 是全因和复发性中风特异性再入院的危险因素。需要进一步研究以解决与遵守和参与医疗保健以减少 DAMA 相关的问题。
