SOP Study Shows Costs Run Higher for Self-discharged CVD Patients

Researchers find that younger cardiovascular patients, as well as males, singles, and uninsured patients, are more likely to discharge themselves from the hospital against medical advice

By Steve Berberich
May 18, 2010

A University of Maryland School of Pharmacy study shows that, among patients with cardiovascular disease (CVD) who discharged themselves from the hospital early, the treatment cost if they are re-admitted runs nine percent higher compared to CVD patients who waited for an appropriate discharge.

On May 17, at the 15th annual meeting of the International Society for Pharmacoeconomics and Outcomes Research in Atlanta, Eberechukwu Onukwugha, PhD, a research assistant professor of pharmaceutical health services research, said, “One thing the study highlights is that instead of a common notion at some facilities that ‘this is a low-cost patient population and we can’t do anything about it,’ there are actually higher costs over time and some of the factors leading to discharges against medical advice are modifiable.”

In first-of-its-kind research, Onukwugha and colleagues studied the records of 347,572 cardiovascular patients in several Maryland hospitals from 2000 to 2005, including 19,779 who were readmitted to the same hospital for further CVD-related care.

In analysis examining the relationship between discharges against medical advice and subsequent readmissions, Onukwugha and colleagues found a stronger effect when considering readmissions to any hospital, not specifically to the same hospital.

Reasons for patients leaving the hospital against medical advice (AMA) include the patient’s preference for their own doctor, too long waiting to see their doctor or nurse, or extenuating circumstances, such as obligations to children, worry over job loss, to pick up a paycheck, or, for a substance abuser, to get a fix.

“But in the end those who leave AMA are more likely to come back in the short run,” said Onukwugha.

She said analysis of ideas from focus groups has shown there is considerable information available to help hospitals keep more CVD patients longer to complete therapy.

Social workers are sometimes needed, or better communications between doctors and nurses, and sometimes there is “cultural insensitivity” when the health care provider is perceived as talking down to the patient.

Younger CVD patients, as well as males, singles, and uninsured patients, are more likely to discharge themselves against medical advice.