WBB's Thought Leadership

Risk Factors of Leaving Against Medical Advice

April 11

According to a study published in the Journal of American Geriatrics Society, patients between the ages of 18-64 and African American and Hispanic elderly patients are at greater risk of hospital readmission due to their tendency to be discharged against medical advice (DAMA).

WBB Take: 
While it is clear that further research is required for hospitals to address and minimize the risks involved with DAMA, we already know enough to regard DAMA as a serious risk to patient safety and quality. By creating strategies to address the root causes of DAMA, hospitals can decrease readmissions, reduce costs, and lower rates of morbidity and mortality.

By focusing on clear communication between physicians, nurses, social workers, mental health professionals, and patients, facilities can avert many cases of DAMA that lead to poor patient outcomes and increased inpatient admissions and emergency department visits. Communication can be improved through staff training, improved patient education, increased availability of translators, and implementation of discharge consultations to ensure patients fully understand risks of refusing care.

In parallel, facilities should determine root causes of any unplanned termination of care that may increase risks to patient safety or care quality. Instances of DAMA, elopement, or patients leaving without being seen (LWBS) should be examined to determine the effect on quality and safety, and to what degree processes, policies, or built environment can be altered to reduce the incidence and associated risks.
Cited by Matthew Loxton, Julia Davis, and Stephanie Owusu

Excerpt: “Data indicate that discharge against medical advice (DAMA) is associated with greater risk of hospital readmission, increased costs, and higher rates of morbidity and mortality. However, there is a lack of national data on DAMA in the rapidly increasing elderly inpatient population in the US.”

“For a study published in the Journal of the American Geriatrics Society, Jashvant Poeran, MD, PhD, Rosanne Leipzig, MD, PhD, and colleagues analyzed data from The National Inpatient Sample to describe trends and assess factors associated with DAMA in elderly patients. ‘Most of the research in this area has been performed in patients younger than 65 and specific patient subgroups such as those with mental health problems,’ says Dr. Leipzig.”

“Study results indicated that from 2003 to 2013, rates increased in individuals aged 18 to 64 (1.44% to 1.78%) and in those aged 65 and older (0.37% to 0.42%). Factors associated with higher adjusted odds of DAMA were generally similar between age groups. ‘However, the risk of discharge against medical advice was much more pronounced among African American and Hispanic elderly patients compared with minority patients aged 18-64,’ says Leipzig.”
Source: Physicians Weekly


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