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Healthcare Resource Utilization Following a Discharge Against Medical Advice: An Analysis of Commercially Insured Adults
Author(s) -
Gandhi Aakash Bipin,
Onukwugha Eberechukwu,
McRae Jacquelyn,
Alfandre David
Publication year - 2020
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.3516
Subject(s) - medicine , health care , hospital medicine , advice (programming) , against medical advice , hospital discharge , medline , medical advice , patient discharge , medical emergency , family medicine , intensive care medicine , nursing , pediatrics , computer science , programming language , political science , law , economics , economic growth
BACKGROUND A discharge against medical advice (DAMA) is associated with adverse health outcomes. Its association with postdischarge healthcare resource utilization (HcRU) outside an inpatient setting is unknown. This information can help us understand how a DAMA may affect healthcare‐seeking behavior following a hospital stay. We evaluated the relationship between a DAMA and 30‐day postdischarge HcRU. METHODS This retrospective cohort study uses a 10% random sample of enrollees in the IQVIA PharMetrics ® Plus database. We included individuals aged 18 to 64 years with an inpatient admission during 2007‐2015 and continuous insurance coverage. We defined comparison groups as DAMA and routine discharge. Both groups were matched on baseline covariates. We quantified the association between a DAMA and 30‐day HcRU, as well as 90‐day for sensitivity analysis, with use of generalized linear models for binary outcomes (inpatient readmissions, emergency department [ED] visits) and count outcomes (physician office visits, nonphysician outpatient encounters, prescription drug fills). RESULTS Of the 457,530 individuals in the unmatched sample, 2,245 (0.5%) had a DAMA. In the matched sample, a DAMA was positively associated with an ED visit (adjusted odds ratio, 2.28; 95% confidence interval, 1.90‐2.72) but not with an inpatient readmission. There were no differences between groups based on the count outcomes. A DAMA was positively associated with 90‐day HcRU (ie, inpatient readmission, ED visit, and prescription drug fills). CONCLUSION The relationship between a DAMA and HcRU varied with the HcRU category and postdischarge time interval. This examination of HcRU in the inpatient and outpatient settings provides important information about outcomes following a DAMA.