Résumé :
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[BDSP. Notice produite par INIST-CNRS n8ytCR0x. Diffusion soumise à autorisation]. Objectives. We examined hospital-and patient-related factors associated with discharge against medical advice (termed self-discharge) after emergency admission to acute-care hospitals. Methods. We analyzed data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project using logistic regression models to assess the relationship between self-discharge and a set of patient and hospital characteristics. Results. Of 3039050 discharges in the sample, 43678 were against medical advice (1.44%). In multivariable modeling, predictors of self-discharge included having Medicaid insurance (adjusted odds ratio [AOR]=3.32 ; 95% confidence interval [Cl]=3.22,3.42), having Medicare insurance (AOR=1.64 ; 95% Cl=1.59,1.70), urban location (AOR=1.66 ; 95% Cl=1.61,1.72), medium (AOR=1.25 ; 95% Cl=1.20,1.29) or large (AOR=1.08,95% Cl=1.05,1.12) hospital (defined by the number of beds), shorter hospital stay (OR=0.84 ; 95% Cl=0.84,0.85), and African American race (AOR=1.10 ; 95% Cl=1.07,1.14). Teaching hospitals had fewer self-discharges (AOR=0.90 ; 95% Cl=0.88,0.92). Other predictors of discharge against medical advice included age, gender, and income. Conclusions. Approximately 1 in 70 hospital discharges in the United States are against medical advice. Both hospital and patient characteristics were associated with these decisions.
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