Treatment costs higher for CVD patients readmitted after leaving hospitals against medical advice

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 readmitted runs 9 percent higher compared to CVD patients who had been formally discharged.

"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," said Eberechukwu Onukwugha, PhD, an assistant professor in the School's department of pharmaceutical health services research.

Onukwugha presented the findings today at the 15th annual meeting of the International Society for Pharmacoeconomics and Outcomes Research in Atlanta.

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.

Patients leave hospitals against medical advice (AMA) for a number of reasons including wanting to see their own doctors, having to wait a long time to see a doctor or nurse or for extenuating circumstances, such as obligations to children, worry over job loss, needing to pick up a paycheck or, in the case of substance abusers, needing to get a fix.

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

In further research, the team learned from analysis of ideas from focus groups that there is considerable information available to help hospitals keep more CVD patients longer to complete therapy.. Sometimes social workers are needed, or better communications between doctors and nurses are necessary. Sometimes there is perceived "cultural insensitivity" when patients feel as though their health care providers are talking down to them.