Advertisement

Maternal and Child Health Journal

, Volume 18, Issue 3, pp 640–647 | Cite as

Predictors and Adverse Pregnancy Outcomes Associated with Antepartum Discharge Against Medical Advice

  • Brownsyne Tucker Edmonds
  • Corinne Ahlberg
  • Katie McPherson
  • Sindhu Srinivas
  • Scott Lorch
Article

Abstract

To determine predictors and pregnancy outcomes associated with antepartum discharge against medical advice (AMA D/C). Retrospective cohort study of state-level maternal and infant hospital discharge data linked to vital statistics data for antepartum admissions in California from 1995 to 2005. (N = 203,250). After adjusting for comorbid conditions, the odds of AMA D/C for Black women were twice that of white women (OR = 2.00, 95 % CI 1.70–2.35). Publicly insured women had 3.5 times the odds of AMA D/C compared to privately insured women (OR = 3.54, 95 % CI 3.02–4.15). AMA D/C was also higher among substance abusers and women with mental illness (OR = 1.96, 95 % CI 1.43–2.67 and OR = 4.45, 95 % CI 3.81–5.21 respectively). Most notably, AMA D/C tripled the odds of fetal death in patients admitted for pregnancy-induced hypertension (OR = 3.08, 95 % CI 1.36–6.98) and increased the odds of neonatal morbidity (respiratory distress syndrome OR = 1.35, 95 % CI 1.07–1.70 and small-for-gestational-age OR = 1.47, 95 % CI 1.15–1.89) in patients admitted with preterm premature rupture of membranes. Vulnerable populations and patients with comorbid medical and mental illnesses are at increased risk for AMA D/C and its associated adverse pregnancy outcomes. Targeted interventions and resources to support at-risk populations are needed.

Keywords

Antepartum admission  Discharge against medical advice  Pregnancy outcomes 

References

  1. 1.
    Hwang, S. W., Li, J., Gupta, R., Chien, V., & Martin, R. E. (2003). What happens to patients who leave hospital against medical advice? Canadian Medical Association Journal, 168(4), 417–420.PubMedCentralPubMedGoogle Scholar
  2. 2.
    Weingart, S. N., Davis, R. B., & Phillips, R. S. (1998). Patients discharged against medical advice from a general medicine service. Journal of General Internal Medicine, 13(8), 568–571.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Anis, A. H., Sun, H., Guh, D. P., Palepu, A., Schechter, M. T., & O’Shaughnessy, M. V. (2002). Leaving hospital against medical advice among HIV-positive patients. Canadian Medical Association Journal, 167(6), 633–637.PubMedCentralPubMedGoogle Scholar
  4. 4.
    Jerrard, D. A., & Chasm, R. M. (2011). Patients leaving against medical advice (AMA) from the emergency department—disease prevalence and willingness to return. The Journal of Emergency Medicine, 41(4), 412–417.CrossRefPubMedGoogle Scholar
  5. 5.
    Pages, K. P., Russo, J. E., Wingerson, D. K., Ries, R. K., Roy-Byrne, P. P., & Cowley, D. S. (1998). Predictors and outcome of discharge against medical advice from the psychiatric units of a general hospital. Psychiatric Services, 49(9), 1187–1192.PubMedGoogle Scholar
  6. 6.
    Southern, W. N., Nahvi, S., & Arnsten, J. H. (2012). Increased risk of mortality and readmission among patients discharged against medical advice. American Journal of Medicine, 125(6), 594–602.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Stranges, E., Wier, L., Merrill, C, & Steiner, C. (2009). Hospitalizations in which patients leave the hospital against medical advice (AMA), 2007 In Quality AfHRa, editor. HCUP Statistical Brief #78. Rockville, MD.Google Scholar
  8. 8.
    Chan, A. C., Palepu, A., Guh, D. P., Sun, H., Schechter, M. T., O’Shaughnessy, M. V., et al. (2004). HIV-positive injection drug users who leave the hospital against medical advice: The mitigating role of methadone and social support. Journal of Acquired Immune Deficiency Syndromes, 35(1), 56–59.CrossRefPubMedGoogle Scholar
  9. 9.
    Moy, E., & Bartman, B. A. (1996). Race and hospital discharge against medical advice. Journal of the National Medical Association, 88(10), 658–660.PubMedCentralPubMedGoogle Scholar
  10. 10.
    Jeremiah, J., O’Sullivan, P., & Stein, M. D. (1995). Who leaves against medical advice? Journal of General Internal Medicine, 10(7), 403–405.CrossRefPubMedGoogle Scholar
  11. 11.
    Ibrahim, S. A., Kwoh, C. K., & Krishnan, E. (2007). Factors associated with patients who leave acute-care hospitals against medical advice. American Journal of Public Health, 97(12), 2204–2208.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Franks, P., Meldrum, S., & Fiscella, K. (2006). Discharges against medical advice: Are race/ethnicity predictors? Journal of General Internal Medicine, 21(9), 955–960.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Aliyu, Z. Y. (2002). Discharge against medical advice: Sociodemographic, clinical and financial perspectives. International Journal of Clinical Practice, 56(5), 325–327.PubMedGoogle Scholar
  14. 14.
    Letterie, G. S., Markenson, G. R., & Markenson, M. M. (1993). Discharge against medical advice in an obstetric unit. Journal of Reproductive Medicine, 38(5), 370–374.PubMedGoogle Scholar
  15. 15.
    Fiscella, K., Meldrum, S., & Franks, P. (2007). Post partum discharge against medical advice: Who leaves and does it matter? Maternal and Child Health Journal, 11(5), 431–436.CrossRefPubMedGoogle Scholar
  16. 16.
    Fiscella, K., Meldrum, S., & Barnett, S. (2007). Hospital discharge against advice after myocardial infarction: Deaths and readmissions. American Journal of Medicine, 120(12), 1047–1053.CrossRefPubMedGoogle Scholar
  17. 17.
    Herrchen, B., Gould, J. B., & Nesbitt, T. S. (1997). Vital statistics linked birth/infant death and hospital discharge record linkage for epidemiological studies. Computers and Biomedical Research, 30(4), 290–305.CrossRefPubMedGoogle Scholar
  18. 18.
    Srinivas, S. K., Fager, C., & Lorch, S. A. (1007). Evaluating risk-adjusted cesarean delivery rate as a measure of obstetric quality. Obstetrics and Gynecology, 115(5), 1007–1013.CrossRefGoogle Scholar
  19. 19.
    Roohan, P. J., Josberger, R. E., Acar, J., Dabir, P., Feder, H. M., & Gagliano, P. J. (2003). Validation of birth certificate data in New York State. Journal of Community Health, 28(5), 335–346.CrossRefPubMedGoogle Scholar
  20. 20.
    Baumeister, L., Marchi, K., Pearl, M., Williams, R., & Braveman, P. (2000). The validity of information on “race” and “Hispanic ethnicity” in California birth certificate data. Health Services Research, 35(4), 869–883.PubMedCentralPubMedGoogle Scholar
  21. 21.
    Braveman, P., Pearl, M., Egerter, S., Marchi, K., & Williams, R. (1998). Validity of insurance information on California birth certificates. American Journal of Public Health, 88(5), 813–816.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Phillippe, M., Frigoletto, F. D., von Oeyen, P., Acker, D., & Kitzmiller, J. L. (1982). High risk antenatal hospitalization. International Journal of Gynaecology and Obstetrics, 20(6), 475–480.CrossRefPubMedGoogle Scholar
  23. 23.
    Krieger, N., Chen, J. T., Waterman, P. D., Rehkopf, D. H., & Subramanian, S. V. (2005). Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: The Public Health Disparities Geocoding Project. American Journal of Public Health, 95(2), 312–323.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Krieger, N., Chen, J. T., Waterman, P. D., Rehkopf, D. H., & Subramanian, S. V. (2003). Race/ethnicity, gender, and monitoring socioeconomic gradients in health: A comparison of area-based socioeconomic measures—the public health disparities geocoding project. American Journal of Public Health, 93(10), 1655–1671.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Rehkopf, D. H., Haughton, L. T., Chen, J. T., Waterman, P. D., Subramanian, S. V., & Krieger, N. (2006). Monitoring socioeconomic disparities in death: Comparing individual-level education and area-based socioeconomic measures. American Journal of Public Health, 96(12), 2135–2138.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Blanchard, J., & Lurie, N. (2004). R-E-S-P-E-C-T: Patient reports of disrespect in the health care setting and its impact on care. Journal of Family Practice, 53(9), 721–730.PubMedGoogle Scholar
  27. 27.
    Gamble, V. N. (1997). Under the shadow of Tuskegee: African Americans and health care. American Journal of Public Health, 87(11), 1773–1778.CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Cooper, L. A., Roter, D. L., Johnson, R. L., Ford, D. E., Steinwachs, D. M., & Powe, N. R. (2003). Patient-centered communication, ratings of care, and concordance of patient and physician race. Annals of Internal Medicine, 139(11), 907–915.CrossRefPubMedGoogle Scholar
  29. 29.
    Cooper-Patrick, L., Gallo, J. J., Gonzales, J. J., Vu, H. T., Powe, N. R., Nelson, C., et al. (1999). Race, gender, and partnership in the patient–physician relationship. JAMA, 282(6), 583–589.CrossRefPubMedGoogle Scholar
  30. 30.
    Roter, D. L., & Hall, J. A. (2004). Physician gender and patient-centered communication: A critical review of empirical research. Annual Review of Public Health, 25(1), 497–519.CrossRefPubMedGoogle Scholar
  31. 31.
    Johnson, R. L., Roter, D., Powe, N. R., & Cooper, L. A. (2004). Patient race/ethnicity and quality of patient–physician communication during medical visits. American Journal of Public Health, 94(12), 2084–2090.CrossRefPubMedCentralPubMedGoogle Scholar
  32. 32.
    ACOG practice bulletin. (2002). Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstetrics and Gynecology, 99(1), 159–167.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Brownsyne Tucker Edmonds
    • 1
  • Corinne Ahlberg
    • 2
  • Katie McPherson
    • 3
  • Sindhu Srinivas
    • 4
  • Scott Lorch
    • 5
  1. 1.Department of Obstetrics and GynecologyIndiana University School of MedicineIndianapolisUSA
  2. 2.Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  3. 3.Indiana University School of MedicineIndianapolisUSA
  4. 4.Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women’s HealthUniversity of Pennsylvania, Maternal and Child Health Research Program, Leonard Davis InstitutePhiladelphiaUSA
  5. 5.Department of Pediatrics, Division of Neonatology, Center for Outcomes ResearchUniversity of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia, Leonard Davis InstitutePhiladelphiaUSA

Personalised recommendations