Factors Associated With Patients Who Leave Acute-Care Hospitals Against Medical Advice

Abstract

Approximately 1 in 70 hospital discharges in the United States are against medical advice. Both hospital and patient characteristics were associated with these decisions.

Factors Associated with Discharge Against Medical Advice from Emergency Department, Universiti Kebangsaan Malaysia Medical Centre

“…Self-paying patients were three times more likely to take DAMA. This finding is comparable to previous studies (Ibrahim et al 2007;Nasir & Babalola 2008;Fiscella et al 2007). This factor is potentially open to modification as policies may be adopted to ease the burden of patients with financial difficulties.…”

“…In previous studies, DAMA patients were found to be young males from low socio-economic status groups and without health insurance (Ibrahim et al 2007;Nasir & Babalola 2008;Pennycook et al 1992). …”

“…The expression of these rights of selfdetermination may result in a patient discharging themselves against medical advice. Discharge against medical resources, and indirectly affects the delivery and quality of care to non-DAMA patients (Moy & Bartman 1996;Ibrahim et al 2007). This results in an increase in burden of health care facilities.…”

Providers’ Perceptions of Relationships and Professional Roles when Caring for Patients who Leave the Hospital Against Medical Advice

“…2 Patients who leave AMA may be at risk for adverse health outcomes leading to more frequent hospital readmissions and increased morbidity and mortality. [3][4][5][6] Prior retrospective chart review studies have found that the likelihood of AMA discharges is associated with hospital factors such as size and location 2 and patient factors such as mental illness, 4,7 substance abuse, 4,5,[7][8][9] gender, 2,5,7-9 income, 2,5 lack of medical insurance, 8,9 whether the individual is a Medicaid recipient, 2,9 race, 2,8-10 and young age 2,5,7,9,11 . One chart review found that providers document patients' reasons for leaving AMA as personal issues, financial problems, and legal matters.…”

Discharge against medical advice: Ethical considerations and professional obligations

“…[1][2][3][4][5][6][7] Patients discharged AMA have higher rates of readmission, longer subsequent hospital stays, and worse health outcomes. 3,5,[8][9][10][11] Not unexpectedly, discharges AMA are associated with overall health costs of up to 50% greater than usual discharges.…”