LAUSR

PURPOSE Annually, 1-2% of hospitalized patients are discharged against medical advice (AMA), positioning them at increased risk of readmission, morbidity, and mortality. The aim of this study was to examine 30-day all-cause readmission rates among AMA discharges in the U.S. and identify disparities across clinically-distinct diagnostic subgroups. METHODS We conducted a retrospective, serial cross-sectional analysis of data from the 2010-2014 Nationwide Readmissions Database. Descriptive statistics and 30-day all-cause readmission rates for hospitalizations among adults aged ≥18 years, were estimated by major diagnostic subgroup, discharge disposition, and patient and hospital characteristics. Odds ratios and 95% confidence intervals were calculated using multi-predictor logistic regression. RESULTS We found the AMA discharge to be an independent predictor of hospital readmission within 30 days, with a 25.6% readmission rate and an overall adjusted likelihood of readmission that was 1.6 to 8 times higher than routine discharges. Further, although hospitalizations experienced decreased odds of readmission post-Hospital Readmission Reduction Program (HRRP) implementation (October 1, 2012), our results demonstrate that the HRRP did not modify the impact of an AMA discharge on readmission. CONCLUSION These findings have implications for practice, policies and interventions aimed improving care quality, preventing A MA discharge and reducing hospital readmissions in inpatient settings.