PURPOSE: To compare the readmission and the mortality rates of schizophrenia patients who were discharged against medical advice (AMA) and patients who were discharged by physician recommendation. METHODS: The records (1984-2005) of all consecutive admissions (n=12,937) of schizophrenia patients (n=8,052) were reviewed. Out of this group, 673 (8.3%) refused to remain in the hospital and signed a hospital form for discharge AMA. Their records were analyzed for rates of re-hospitalization and mortality at study closure. The records of AMA patients were compared to those of patients with regular discharge (n=1345). RESULTS: AMA patients were younger at admission (P<0.001), comprised more males (P<0.01), more were single (P<0.0001), and had a shorter duration of illness than the controls (P<0.05). A total of 49.9% of AMA events occurred within the first 2 weeks of hospitalization. The readmission rate was significantly higher for AMA patients than for the controls (P<0.001). The mortality rate as a result of suicide (P<0.0001) and accidents (P<0.05) was higher for AMA patients compared to controls. CONCLUSION: The schizophrenia patients discharged AMA have a higher readmission rate and a higher mortality rate due to suicide and accidents compared to non-AMA discharged patients. Patients with AMA discharge warrant special community surveillance to improve outcome.
PURPOSE: To compare the readmission and the mortality rates of schizophreniapatients who were discharged against medical advice (AMA) and patients who were discharged by physician recommendation. METHODS: The records (1984-2005) of all consecutive admissions (n=12,937) of schizophreniapatients (n=8,052) were reviewed. Out of this group, 673 (8.3%) refused to remain in the hospital and signed a hospital form for discharge AMA. Their records were analyzed for rates of re-hospitalization and mortality at study closure. The records of AMA patients were compared to those of patients with regular discharge (n=1345). RESULTS: AMA patients were younger at admission (P<0.001), comprised more males (P<0.01), more were single (P<0.0001), and had a shorter duration of illness than the controls (P<0.05). A total of 49.9% of AMA events occurred within the first 2 weeks of hospitalization. The readmission rate was significantly higher for AMA patients than for the controls (P<0.001). The mortality rate as a result of suicide (P<0.0001) and accidents (P<0.05) was higher for AMA patients compared to controls. CONCLUSION: The schizophreniapatients discharged AMA have a higher readmission rate and a higher mortality rate due to suicide and accidents compared to non-AMA discharged patients. Patients with AMA discharge warrant special community surveillance to improve outcome.
Authors: Florian Walter; Matthew J Carr; Pearl L H Mok; Sussie Antonsen; Carsten B Pedersen; Jenny Shaw; Roger T Webb Journal: J Clin Psychiatry Date: 2018-10-02 Impact factor: 4.384
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Authors: Florian Walter; Matthew J Carr; Pearl L H Mok; Aske Astrup; Sussie Antonsen; Carsten B Pedersen; Jenny Shaw; Roger T Webb Journal: JAMA Psychiatry Date: 2017-05-01 Impact factor: 21.596
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