Risk Factors for Discharge Against Medical Advice at Antepartum Hospitalizations [ID: 1373372

Abstract

INTRODUCTION: Antepartum obstetrical admissions are often unplanned. Despite counseling, some patients may choose to be discharged against medical advice (DAMA). This study examined patterns of DAMA at antepartum hospitalizations and associated patient characteristics. METHODS: Using 2019 National Inpatient Sample (NIS) data, we identified pregnant patients aged 12–50 years with antepartum admissions. The primary outcome was DAMA determined based on patients' discharge disposition status. Patients' sociodemographic and clinical characteristics were measured based on hospital discharge records and diagnosis/procedure codes. Characteristics of DAMA and non-DAMA patients were compared using chi-square tests and multivariable logistic regression, while accounting for NIS complex sample design to generate nationally representative estimates. RESULTS: Among 214,935 patients in the sample, 8,495 (4.0%) were DAMA. The risk of DAMA was significantly higher among Black than White patients (5.4% versus 3.8%, P<.001, adjusted odds ratio [OR] 1.25, 95% CI 1.09–1.43), Medicaid than privately insured patients (5.4% versus 1.7%, P<.001, adjusted OR 2.49, 95% CI 2.12–2.93), and patients with (versus without) obstetrical/comorbid conditions, such as substance use disorders (11.3% versus 2.7%, P<.001, adjusted OR 3.30, 95% CI 2.76–3.96), prior preterm birth (8.1% versus 3.9%, P<.001, adjusted OR 2.04, CI 1.44–2.89), hypertensive disorders of pregnancy (5.4% versus 3.8%, P<.001, adjusted OR 1.70, 95% CI 1.43–2.03), and chronic hypertension (6.2% versus 3.8%, P<.001, adjusted OR 1.51, 95% CI 1.28–1.79). CONCLUSION: Patients who are DAMA in the antepartum period have certain sociodemographic and clinical characteristics that may place them at higher risk of adverse obstetrical outcomes. Risk-stratified, targeted patient support during admission may be beneficial.