在新冠肺炎早期大流行期间,谁违背医疗建议离开了医院?

HCA healthcare journal of medicine Pub Date : 2023-08-29 eCollection Date: 2023-01-01 DOI:10.36518/2689-0216.1530
Bryan Werner, Se Won Lee
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引用次数: 0

摘要

背景:在竞争日益激烈的市场中,患者违背医嘱离开(AMA)给医院带来了挑战,因为他们试图管理成本并改善患者的预后。调查新冠肺炎大流行早期发生的AMA放电提供了一个独特的机会,可以更好地了解这一现象,并为未来做好更好的准备。方法:这项对来自20个州的全国私人医疗保健系统的34379名患者的回顾性分析分析了疫情早期因感染新冠肺炎而选择违背医疗建议(AMA)离开的患者,并确定了与随后的AMA出院相关的几个患者特征。结果:这些患者特征包括年龄小于50岁;认定为男性;非白人,包括黑人和西班牙裔;有医疗补助或没有医疗保险;以及特定医学合并症的存在。已确定的医学合并症为药物滥用、肾衰竭、深静脉血栓形成、高血压伴心力衰竭、高血压伴慢性肾脏疾病5期、类风湿性关节炎或胶原血管疾病、酗酒、慢性肺病、高血压脑病和实体瘤。结论:这项研究证实了之前关于AMA出院的研究中的一些发现,并有一些有趣的发现,因为它与COVID-19感染患者群体特别相关。进一步了解导致AMA出院的因素可以帮助提供者和管理人员防止未来出现次优出院结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Who Left the Hospital Against Medical Advice During the Early COVID-19 Pandemic?

Background: Patients leaving against medical advice (AMA) presents a challenge to hospitals as they try to manage costs and improve patient outcomes in an ever-increasing competitive market. Investigating AMA discharges that occurred during the early COVID-19 pandemic presents a unique opportunity to better understand this phenomenon and be better prepared for the future.

Methods: This retrospective analysis of 34 379 patients from a nationwide private healthcare system across 20 states analyzed patients during the early stages of the pandemic who chose to leave against medical advice (AMA) after being admitted with COVID-19 infection and identified several patient characteristics associated with subsequent AMA discharge.

Results: These patient characteristics included being younger than 50; identifying as male sex; having non-white ethnicity, including both Black and Hispanic; having either Medicaid or no health insurance; and the presence of specific medical comorbidities. The identified medical comorbidities were substance abuse, renal failure, deep vein thrombosis, hypertension with heart failure, hypertension with chronic kidney disease stage 5, rheumatoid arthritis or collagen vascular diseases, alcohol abuse, chronic pulmonary disease, hypertensive encephalopathy, and solid tumor.

Conclusion: This study confirms some of the findings in previous studies looking at AMA discharges and has some interesting findings as it relates specifically to the COVID-19-infected patient population. An additional understanding of the factors leading to AMA discharges can help providers and administrators prevent suboptimal discharge outcomes in the future.

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