Affiliations: [a] Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA | [b] Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD, USA
Correspondence:
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Address for correspondence: Ebere Onukwugha, PhD, Assistant Professor, Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, USA. Tel.: +1 410 706 8981/Fax: +1 410 706 5394; E-mail: eonukwug@rx.umaryland.edu
Abstract: Introduction:Predictors of hospital discharges against medical advice (AMA), including race/ethnicity, have been examined previously. However, the predictive effect of an admission for rehabilitative care has not been examined in an inpatient stroke population, nor has the impact of race/ethnicity on this relationship been reported. Methods:Live hospital discharges with a primary diagnosis of stroke from 2000–2005 were identified in a longitudinal dataset. The outcome of interest was a discharge AMA. A hierarchical logistic model was estimated to examine the effect of race/ethnicity and rehabilitative care on the outcome while controlling for patient and hospital characteristics. Results:A total of 569 of the 79,561 stroke admissions (0.7%) ended in a discharge AMA. There were 1,565 admissions for rehabilitative care and 32% of patients were non-Caucasian. Among Caucasians, adjusted odds of a discharge AMA were higher for patients with an admission for rehabilitative care (AOR = 3.83, p < 0.0001). Among those not admitted for rehabilitative care, non-Caucasian patients were more likely to leave AMA (AOR = 1.4; p = 0.0005). Conclusions:This study identifies dependence between race/ethnicity, rehabilitative care, and discharges AMA. More research is needed to understand the implications of differential rates of discharges AMA among race/ethnic groups and across patient care settings.
Keywords: Discharges against medical advice, stroke, rehabilitation, ethnicity
