Leaving Against Medical Advice From Children's Hospitals.

Autor:	Campbell JI; Section of Pediatric Infectious Diseases.; Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts., Tolliver DG; Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.; Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts., He Y; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania., Wang RY; Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts.; Boston Combined Residency Program, Boston Children's Hospital and Boston Medical Center, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts., Shapiro J; Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.; Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts., Shanahan K; Harvard Medical School, Boston, Massachusetts.; Department of Emergency Medicine, Mass General for Children, Boston, Massachusetts., Mell A; Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.; Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts., Luercio M; Harvard Medical School, Boston, Massachusetts.; Department of Pediatrics.; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion.; Office of Health Equity and Inclusion., Shah SN; Harvard Medical School, Boston, Massachusetts.; Department of Pediatrics.; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion.; Office of Health Equity and Inclusion., Hall M; Children's Hospital Association, Lenexa, Kansas., Goel AK; Office of General Counsel, Boston Children's Hospital, Boston, Massachusetts., Melvin P; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion.; Office of Health Equity and Inclusion., Ward VL; Department of Pediatrics.; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion.; Office of Health Equity and Inclusion.; Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts., Berry J; Harvard Medical School, Boston, Massachusetts.; Department of Pediatrics.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2024 Nov 01; Vol. 154 (5).
DOI:	10.1542/peds.2023-064958
Abstrakt:	Background: Leaving the hospital against medical advice (AMA) reflects a breakdown in the family-clinician relationship and creates ethical dilemmas in inpatient pediatric care. There are no national data on frequency or characteristics of leaving AMA from US children's hospitals. Methods: We performed a retrospective cohort study of hospital discharges for children under 18 years old from January 1, 2018 to December 31, 2022 in 43 children's hospitals in the Pediatric Health Information System (PHIS) database. The primary outcome was leaving AMA. Exposures were demographic, geographic, and clinical characteristics. We used multivariable mixed effects logistic regression models to assess independent factors associated with leaving AMA and all-cause 14-day hospital readmission. Results: Among 3 672 243 included inpatient encounters, 2972 (0.08%) ended in leaving AMA. Compared with non-Hispanic white patients, non-Hispanic Black patients had higher odds of leaving AMA (adjusted odds ratio [aOR] 1.31 [95% confidence interval (CI) 1.19-1.44]), whereas Hispanic patients (aOR 0.66 [95% CI 0.59-0.75]) had lower odds of leaving AMA. Hospitalizations for patients with noncommercial insurance were more likely to end in leaving AMA. Leaving AMA was associated with increased odds of 14-day inpatient readmission (aOR 1.41 [95% CI 1.24-1.61]) compared with patients who did not leave AMA. There was substantial interhospital variability in standardized rates of leaving AMA (range 0.18-2.14 discharges per 1000 inpatient encounters). Conclusions: Approximately 1 in 1235 inpatient encounters ended in leaving AMA. Non-Hispanic Black patients had increased odds of leaving AMA. Leaving AMA was associated with increased odds of 14-day readmission. (Copyright © 2024 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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