Hospital self-discharge among adults with sickle-cell disease (SCD): Associations with trust and interpersonal experiences with care

Authors

  • Carlton Haywood Jr PhD, MA,

    Corresponding author
    1. Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    2. Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland
    • Division of Hematology, The Johns Hopkins University School of Medicine, Associate Faculty, The Johns Hopkins Berman Institute of Bioethics, 624 N. Broadway, Hampton House, Room 355, Baltimore, MD 21205
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    • Telephone: 410-614-6335; Fax: 410-614-9567

  • Sophie Lanzkron MD, MHS,

    1. Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Neda Ratanawongsa MD, MPH,

    1. Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
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  • Shawn M. Bediako PhD,

    1. Department of Psychology, University of Maryland Baltimore County, Baltimore, Maryland
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  • Lakshmi Lattimer-Nelson MD,

    1. Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Mary Catherine Beach MD, MPH

    1. Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    2. Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland
    3. Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Supported by the Johns Hopkins Blaustein Pain Research Fund (to M.C.B), a National Research Service Award from the National Heart, Lung and Blood Institute (5F31HL082037-03 to C.H.), and a grant from the Agency for Healthcare Research and Quality (K08 HS013903-05 to M.C.B.). M.C.B. is a recipient of a Robert Wood Johnson Generalist Physician Faculty Scholars Award. S.L. was supported by a mentored career award from the National Heart, Lung and Blood Institute (5K23HL083089-02).

  • Disclosure: Nothing to report.

Abstract

BACKGROUND:

Patient self-discharge from hospitals has been associated with a number of negative clinical outcomes. Research suggests that low patient trust and poor quality interpersonal experiences with care may be associated with hospital self-discharge. Although adults with sickle-cell disease (SCD) often report poorer quality healthcare experiences, research examining hospital self-discharge and its associations with both patient trust and quality of healthcare experiences is lacking for this patient population.

OBJECTIVE:

To examine the association of interpersonal experiences with care and trust in the medical profession with hospital self-discharge history among patients with SCD.

DESIGN:

Cross-sectional study.

SETTING:

A large, urban academic medical center.

PATIENTS:

Adults (age 18+ years) with SCD seeking outpatient or inpatient care.

MEASUREMENTS:

We compared patient characteristics, patient perceptions of the quality of interpersonal experiences with care, and levels of trust between patients with and without a history of hospital self-discharge.

RESULTS:

Adjusted analyses indicated that having a history of hospital self-discharge was associated with more negative interpersonal experiences and lower levels of trust.

CONCLUSIONS:

Hospital self-discharge may be an important indicator of the quality of care received by adults with SCD. Further research is needed to better understand this phenomenon so that effective interventions can be designed to prevent its occurrence. Journal of Hospital Medicine 2010;5:289–294. © 2010 Society of Hospital Medicine.

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