Factors Associated with Patients Who Leave Acute-care Hospitals Against Medical Advice

Overview

Journal Am J Public Health

Specialty Public Health

Date 2007 Nov 1

PMID 17971552

Citations 68

Authors

Said A Ibrahim

C Kent Kwoh

Eswar Krishnan

Affiliations

Soon will be listed here.

Abstract

Objectives: We examined hospital- and patient-related factors associated with discharge against medical advice (termed self-discharge) after emergency admission to acute-care hospitals.

Methods: We analyzed data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project using logistic regression models to assess the relationship between self-discharge and a set of patient and hospital characteristics.

Results: Of 3,039,050 discharges in the sample, 43 678 were against medical advice (1.44%). In multivariable modeling, predictors of self-discharge included having Medicaid insurance (adjusted odds ratio [AOR]=3.32; 95% confidence interval [CI]=3.22, 3.42), having Medicare insurance (AOR=1.64; 95% CI=1.59, 1.70), urban location (AOR=1.66; 95% CI=1.61, 1.72), medium (AOR=1.25; 95% CI=1.20, 1.29) or large (AOR=1.08, 95% CI=1.05, 1.12) hospital (defined by the number of beds), shorter hospital stay (OR=0.84; 95% CI=0.84, 0.85), and African American race (AOR=1.10; 95% CI=1.07, 1.14). Teaching hospitals had fewer self-discharges (AOR=0.90; 95% CI=0.88, 0.92). Other predictors of discharge against medical advice included age, gender, and income.

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

Citing Articles

Discharge Against Medical Advice From the Emergency Department: Results From a Private Hospital in Beirut.

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Care Complexity Factors and Discharge Destination in an Emergency Department: A Retrospective Cohort Study.

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"Before medically advised" departure from hospital and subsequent drug overdose: a population-based cohort study.

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Leaving Against Medical Advice: Current Problems and Plausible Solutions.

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Patient-Physician Sex Discordance and "Before Medically Advised" Discharge from Hospital: A Population-Based Retrospective Cohort Study.

Khan M, Yu Y, Daly-Grafstein D, Naik H, Sutherland J, Tran K J Gen Intern Med. 2024; 39(14):2638-2648.

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