Inflammatory bowel disease patients who leave hospital against medical advice: predictors and temporal trends

Gilaad G Kaplan, Remo Panaccione, James N Hubbard, Geoffrey C Nguyen, Abdel Aziz M Shaheen, Christopher Ma, Shane M Devlin, Yvette Leung, Robert P Myers
Inflammatory Bowel Diseases 2009, 15 (6): 845-51

BACKGROUND: Leaving hospital against medical advice (AMA) may have consequences with respect to health-related outcomes; however, inflammatory bowel disease (IBD) patients have been inadequately studied. Thus, we determined the prevalence of self-discharge, assessed predictors of AMA status, and evaluated time trends.

METHODS: We analyzed the 1995-2005 Nationwide Inpatient Sample (NIS) to identify 93,678 discharges with a primary diagnosis of IBD admitted to the hospital emergently and did not undergo surgery. We described the proportion of IBD patients who left AMA. Predictors of AMA status were evaluated using a multivariate logistic regression model and temporal trend analyses were performed with Poisson regression models.

RESULTS: Between 1995 and 2005, 1.31% of IBD patients left hospitals AMA. Crohn's disease (CD) patients were more likely to leave AMA (adjusted odds ratio [aOR], 1.53; 95% confidence intervals [CI]: 1.30-1.79). Characteristics associated with leaving AMA included: ages 18-34 (aOR, 7.77, 95% CI: 4.34-13.89); male (aOR, 1.75; 95% CI: 1.55-1.99); Medicaid (aOR, 4.55; 95% CI: 3.81-5.43) compared to private insurance; African Americans (aOR, 1.34; 95% CI: 1.09-1.64) compared to white; substance abuse (aOR, 2.75; 95% CI: 2.14-3.54); and psychosis (aOR, 1.55; 95% CI: 1.13-2.14). The incidence rates of self-discharge for CD patients were stable (P > 0.05) between 1995 and 1999, while they significantly (P < 0.0001) increased after 1999. In contrast, AMA rates for UC patients remained stable during the study period.

CONCLUSIONS: Approximately 1 in 76 IBD patients admitted emergently for medical management leave the hospital AMA. These were primarily disenfranchised patients who may lack adequate outpatient follow-up.

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