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

被引：7

作者：

Edmonds, Brownsyne Tucker ^{[1
]}

Ahlberg, Corinne ^{[2
]}

McPherson, Katie ^{[3
]}

Srinivas, Sindhu ^{[4
]}

Lorch, Scott ^{[5
]}

机构：

[1] Indiana Univ, Sch Med, Dept Obstet & Gynecol, Indianapolis, IN 46202 USA

[2] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[3] Indiana Univ, Sch Med, Indianapolis, IN USA

[4] Univ Penn, Maternal & Child Hlth Res Program, Ctr Res Reprod & Womens Hlth, Dept Obstet & Gynecol,Leonard Davis Inst, Philadelphia, PA 19104 USA

[5] Univ Penn, Childrens Hosp Philadelphia, Ctr Outcomes Res, Dept Pediat,Div Neonatol,Sch Med,Leonard Davis In, Philadelphia, PA 19104 USA

来源：

MATERNAL AND CHILD HEALTH JOURNAL | 2014年 / 18卷 / 03期

关键词：

Antepartum admission; Discharge against medical advice; Pregnancy outcomes; PATIENT-CENTERED COMMUNICATION; HOSPITAL DISCHARGE; HEALTH; RACE/ETHNICITY; DISPARITIES; GENDER; LEAVE; CARE; RACE; INFORMATION;

D O I：

10.1007/s10995-013-1288-8

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

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.

引用

页码：640 / 647

页数：8