Osweiler Bailey W, Hutson William D, Marotta Phillip L
J Addict Med. 2025 Jun 23. doi: 10.1097/ADM.0000000000001521.
The United States is in an overdose crisis, with many Americans seeking emergency medical services for drug overdose. Patients who leave against medical advice (AMA) have higher risk of subsequent health complications and hospital readmission. This cross-sectional study uses electronic health records (EHRs) to identify insurance-related risk factors for leaving AMA among patients hospitalized for opioid overdose.
Documented opioid overdose hospitalizations between June 2019 and November 2021 were identified using ICD-10 codes from EHR at a large Midwest academic hospital. Multivariate logistic regression was used to identify risk factors associated with leaving AMA. Opioid overdose hospitalizations were aggregated by patient, and bivariate analyses (χ2, ANOVA) and logistic regression were used to test for associations between demographics and repeat hospitalization.
Among 3608 hospitalizations, 2985 unique patients were admitted. Compared with Medicare, patients with all other specified insurance types were more likely to leave AMA: self-pay 294% more (aOR = 3.94; 95% CI = 1.83-10.34), Medicaid 299% more (aOR = 3.99; 95% CI = 1.78-10.72), and commercial 402% more (aOR = 5.02; 95% CI = 1.88-14.94). Risk factors for repeat hospitalization included black race (aOR = 1.61, 95% CI = 1.26,2.07), and young age (aOR = 0.99, 95% CI = 0.98, 0.99), while female sex was associated with decreased odds (aOR = 0.73, 95% CI = 0.57, 0.92).
Insurance may be associated with AMA discharge after opioid overdose. Tailored interventions addressing patients' financial concerns after hospitalization may increase access to care and reduce inequities.
美国正处于药物过量危机之中，许多美国人因药物过量寻求紧急医疗服务。擅自离院（AMA）的患者后续出现健康并发症和再次住院的风险更高。这项横断面研究利用电子健康记录（EHR）来确定因阿片类药物过量住院的患者中与擅自离院相关的保险风险因素。
利用中西部一家大型学术医院电子健康记录中的ICD-10编码，确定2019年6月至2021年11月期间有记录的阿片类药物过量住院病例。采用多变量逻辑回归来确定与擅自离院相关的风险因素。阿片类药物过量住院病例按患者进行汇总，并采用双变量分析（χ2检验、方差分析）和逻辑回归来检验人口统计学特征与再次住院之间的关联。
在3608例住院病例中，有2985例不同患者入院。与医疗保险患者相比，所有其他特定保险类型的患者更有可能擅自离院：自费患者的可能性高294%（调整后比值比[aOR]=3.94；95%置信区间[CI]=1.83-10.34），医疗补助患者高299%（aOR=3.99；95%CI=1.78-10.72），商业保险患者高402%（aOR=5.02；95%CI=1.88-14.94）。再次住院的风险因素包括黑人种族（aOR=1.61，95%CI=1.26，2.07）和年轻（aOR=0.99，95%CI=0.98，0.99），而女性的可能性则较低（aOR=0.73，95%CI=0.57，0.92）。
保险可能与阿片类药物过量后的擅自离院出院有关。针对患者住院后的经济担忧采取有针对性的干预措施，可能会增加获得医疗服务的机会并减少不平等现象。
