Acute & General Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
Centre for Discovery Brain Sciences, The University of Edinburgh, Edinburgh, UK
BMJ Open. 2023 Mar 27;13(3):e068801. doi: 10.1136/bmjopen-2022-068801.
To assess the frequency of discharge against medical advice (DAMA) in a large UK teaching hospital, explore factors which increase the risk of DAMA and identify how DAMA impacts patient risk of mortality and readmission.
Retrospective cohort study.
Large acute teaching hospital in the UK.
36 683 patients discharged from the acute medical unit of a large UK teaching hospital between 1 January 2012 and 31 December 2016.
Patients were censored on 1 January 2021. Mortality and 30-day unplanned readmission rates were assessed. Deprivation, age and sex were taken as covariates.
3% of patients discharged against medical advice. These patients were younger (median age (years) (IQR)): planned discharge (PD) 59 (40-77); DAMA 39 (28-51), predominantly of male sex (PD 48%; DAMA 66%) and were of greater social deprivation (in three most deprived quintiles PD 69%; DAMA 84%). DAMA was associated with increased risk of death in patients under the age of 33.3 years (adjusted HR 2.6 (1.2-5.8)) and increased incidence of 30-day readmission (standardised incidence ratio 1.9 (1.5-2.2)).
Readmission to acute hospitals outside of the local health board may have been missed. We were unable to include information regarding comorbidity or severity of presentation.
These data highlight the vulnerability of younger patients who DAMA, even in a free-at-the-point-of-delivery healthcare setting.
评估在一家大型英国教学医院中，不遵医嘱出院（DAMA）的频率，探讨增加 DAMA 风险的因素，并确定 DAMA 如何影响患者的死亡和再入院风险。
回顾性队列研究。
英国一家大型急性教学医院。
2012 年 1 月 1 日至 2016 年 12 月 31 日期间从英国一家大型教学医院急性内科病房出院的 36683 名患者。
患者于 2021 年 1 月 1 日截止。评估死亡率和 30 天非计划性再入院率。贫困程度、年龄和性别被视为协变量。
3%的患者不遵医嘱出院。这些患者年龄更小（中位数年龄（岁）（IQR））：计划出院（PD）59（40-77）；DAMA 39（28-51），主要为男性（PD 48%；DAMA 66%），社会贫困程度更高（在最贫困的三个五分位数中，PD 69%；DAMA 84%）。DAMA 与 33.3 岁以下患者的死亡风险增加相关（调整后的 HR 2.6（1.2-5.8）），且 30 天再入院率增加（标准化发病率比 1.9（1.5-2.2））。
可能遗漏了在当地卫生委员会之外的急性医院的再入院情况。我们无法纳入关于合并症或发病严重程度的信息。
这些数据突出了 DAMA 的年轻患者的脆弱性，即使在免费的医疗保健环境中也是如此。
