An examination of discharge against medical advice from brain injury inpatient rehabilitation

Abstract

Objective: Discharges against medical advice (DAMA) have been considered predictors of adverse outcomes for patients in acute care and psychiatric hospitals. However, little is known about the profile of patients who discharge AMA admitted to rehabilitation hospitals. The aims of this study were to provide a profile of patients who received inpatient rehabilitation services following a traumatic brain injury (TBI) who discharged AMA and to compare this group with the regular discharge group.

Research design: Retrospective cohort study.

Methods: Hospital discharge data from two national administrative databases were reviewed for the years 2001–2006.

Results: The databases yielded 1559 cases of TBI (average length of stay = 51 days). Of these, 31 (2.0%) had recorded DAMA events: one in 50 patients left rehabilitation against medical advice. Compared to regular discharge (n = 1247), DAMA was significantly associated with unemployment, intentional injury, higher motor functions at admission and shorter length of stay. Known factors for DAMA in acute hospitals, such as male sex, young age and substance abuse history, were not significant.

Conclusion: Careful screening and assessment of patients who discharge AMA could enable better prevention and management strategies, thus improving health outcomes and enhancing healthcare delivery.

• Case management
• rehabilitation
• service delivery

Acknowledgements

The authors thank the Canadian Institute for Health Information (CIHI) for providing access to National Rehabilitation Reporting System (NRS) data and for use of the FIM^™ instrument. The FIM^™ instrument, data set and impairment codes referenced herein are the property of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc. We also thank Sandra Sokoloff and Stephanie Burdzy for support in preparing this manuscript.

Declaration of Interest: The authors report no conflicts of interest. Financial support was provided by the Canadian Institutes for Health Research Strategic Team Grant in Applied Injury Research # TIR-103946, the Ontario Neurotrauma Foundation, a fellowship through the Toronto Rehabilitation Institute, and a grant to TRI from the Ministry of Health and Long Term Care.