Predictors of leaving before medically advised and subsequent 30-day hospital revisits among patients hospitalized for substance use-related conditions: A retrospective cohort study.

Abstract

People who use substances (PWUS) experience high rates of hospitalization and frequently leave the hospital before medically advised (BMA), which may contribute to poor health outcomes and increased healthcare utilization. This study aimed to identify factors associated with BMA discharge and evaluate the association between BMA discharge and 30-day ED revisits among PWUS hospitalized in Northern Ontario. This retrospective cohort study used de-identified administrative and clinical data from Health Sciences North between January 1, 2018 and March 31, 2024. Participants included patients presenting to the ED or admitted directly to hospital with substance use identified as a diagnosis using ICD-10-CA F10-F19 codes. Multivariable logistic regression models were used to identify factors associated with BMA discharge and 30-day revisits. The cohort included 8780 hospital admissions for substance use-related presentations, of which 798 (9.09%) resulted in BMA discharge. In adjusted analyses, homelessness (OR = 2.49, 95% CI: 2.02-3.08) and male sex (OR = 1.50, 95% CI: 1.0-1.82) associated with increased likelihood of BMA discharge. Admission to the Addiction Medicine Unit was associated with a reduced likelihood of BMA (OR = 0.66, 95% CI: 0.53-0.83). Patients who left BMA were significantly more likely to have a 30-day ED revisit compared to patients who did not leave BMA (aOR = 1.86, 95% CI: 1.50-2.31). BMA discharge among PWUS is associated with significantly increased likelihood of 30-day ED revisits. Specialized addiction services may reduce premature discharge.