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Journal article
Hospital and emergency department discharge against medical advice in Western Australian Aboriginal children aged 0-4 years from 2002 to 2018: A cohort study
Paediatric and perinatal epidemiology, Vol.37, pp.691-703
2023
Abstract
Background
Discharge against medical advice (DAMA) is a priority issue for the health system. Little is known about the factors associated with DAMA for Aboriginal and/or Torres Strait Islander (Aboriginal) children in Australia.
Objectives
Investigate the associations between DAMA for hospital admissions and emergency department (ED) presentations and: (i) child, family and episode of service characteristics and (ii) 30-day readmission/ re-presentation.
Methods
We conducted a cohort study of Aboriginal children born in Western Australia (2002–2013) who had ≥1 hospital admissions (n = 16,931) or ED presentations (n = 26,546) within the first 5 years of life. The outcome of interest was hospital and ED DAMA and adjusted odds ratio were derived using multilevel mixed-effects logistic regression.
Results
In the Hospital Cohort, there were 43,149 hospitalisations for 16,931 children, with 684 hospitalisations (1.6%) recorded as DAMA. In the ED Cohort, there were 232,082 ED presentations in 26,546 children, with 10,918 ED presentations (4.7%) recorded as DAMA. DAMA occurring in hospitals between 2014 and 2018, the adjusted odds decreased by 75% compared to the period between 2002 and 2005. The adjusted odds of ED DAMA increased by 46% over the same period. Hospital admissions in regional and remote hospitals were almost seven times the adjusted odds of DAMA compared with hospital admissions in Perth metropolitan hospitals. The adjusted odds of ED DAMA decreased by 12% for ED presentations in regional and remote hospitals compared to those in Perth metropolitan hospitals. There was no evidence of hospital DAMA being associated with hospital readmission within 30 days and limited evidence of ED DAMA being associated with re-presenting to an ED within 30 days.
Conclusions
The study identified several important determinants of DAMA, including admission status, triage status, location and calendar year. These findings could inform targeted measures to decrease DAMA, particularly in regional and remote communities.
Details
- Title
- Hospital and emergency department discharge against medical advice in Western Australian Aboriginal children aged 0-4 years from 2002 to 2018: A cohort study
- Authors/Creators
- Daniel ChristensenAlison Gibberd - The University of MelbourneBridgette McNamara - The University of MelbourneSandra Eades - The University of MelbourneCarrington Shepherd - Murdoch University, Ngangk Yira Institute for ChangeDavid B Preen - The University of Western AustraliaDaniel McAullay - The Kids Research Institute AustraliaNatalie Strobel - Edith Cowan University
- Publication Details
- Paediatric and perinatal epidemiology, Vol.37, pp.691-703
- Publisher
- John Wiley & Sons Ltd.
- Identifiers
- 991005617460807891
- Copyright
- © 2023 The Authors.
- Murdoch Affiliation
- Ngangk Yira Institute for Change
- Language
- English
- Resource Type
- Journal article
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