Eberechukwu Onukwugha

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The dual impact of rehabilitation admission and race/ethnicity on discharges against medical advice.

E Onukwugha; M R Weir (Profiled Authors: Matthew R Weir; Eberechukwu Onukwugha)

Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA. eonukwug@rx.umaryland.edu
NeuroRehabilitation 2009;24(1):67-74.

INTRODUCTION: Predictors of hospital discharges against medical advice (AMA), including race/ethnicity, have been examined previously. However, the predictive effect of an admission for rehabilitative care has not been examined in an inpatient stroke population, nor has the impact of race/ethnicity on this relationship been reported. METHODS: Live hospital discharges with a primary diagnosis of stroke from 2000-2005 were identified in a longitudinal dataset. The outcome of interest was a discharge AMA. A hierarchical logistic model was estimated to examine the effect of race/ethnicity and rehabilitative care on the outcome while controlling for patient and hospital characteristics. RESULTS: A total of 569 of the 79,561 stroke admissions (0.7%) ended in a discharge AMA. There were 1,565 admissions for rehabilitative care and 32% of patients were non-Caucasian. Among Caucasians, adjusted odds of a discharge AMA were higher for patients with an admission for rehabilitative care (AOR = 3.83, p < 0.0001). Among those not admitted for rehabilitative care, non-Caucasian patients were more likely to leave AMA (AOR = 1.4; p = 0.0005). CONCLUSIONS: This study identifies dependence between race/ethnicity, rehabilitative care, and discharges AMA. More research is needed to understand the implications of differential rates of discharges AMA among race/ethnic groups and across patient care settings.

1 Originating Grant

• 1.

  Shuldiner, Alan R

  Clinical Research Career Development (RMI)

  23 September 2005 - 31 July 2010

  NATIONAL CENTER FOR RESEARCH RESOURCES

Scientific Context

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