Characteristics of Trauma Patients That Leave Against Medical Advice: An Eight-year Survey Analysis Using the National Hospital Ambulatory Medical Care Survey, 2009-2016

Overview

Journal J Clin Orthop Trauma

Specialty Orthopedics

Date 2021 Mar 8

PMID 33680838

Citations 4

Authors

Oluwaseun John Adeyemi

Shelby Veri

Affiliations

Soon will be listed here.

Abstract

Background: Leaving against medical advice (AMA) is associated with increased readmission rates, fragmented patient care, and healthcare litigation. Understanding the factors associated with trauma patients leaving AMA from acute care settings will help guide better communication with trauma patients and improve patient satisfaction. This study aims to assess the sociodemographic and in-hospital care characteristics of trauma patients that leave AMA from acute care centers across the U.S.

Methods: We pooled and analyzed eight years of data (2009-2016) from the National Hospital Ambulatory Medical Care Survey. The outcome variable was whether the patient left AMA or not. The main predictors were the triage class, weekend presentation, health insurance status, the presence of chronic diseases, and the receipt of therapeutic and diagnostic procedures. The sociodemographic characteristics -age, sex, and race/ethnicity, were measured as potential confounders in the developed model. We performed logistic regression and reported the unadjusted and adjusted odds of leaving AMA as well as the 95% confidence intervals.

Results: The weighted percent of the trauma patient population that left AMA was 1.8%. The odds of leaving AMA decreased with advancing age, and increased among non-Hispanic Blacks, compared with non-Hispanic Whites. After adjusting for age, race, and gender, the odds of leaving AMA increased among patients that lacked health insurance (AOR: 1.86; 95% CI: 1.51-2.31), and had diagnostic procedures (AOR: 2.79; 95% CI: 2.32-3.36). The odds of leaving AMA reduced among trauma patients who were classified as emergent (AOR: 0.70; 95% CI: 0.50-0.98) and had therapeutic procedures (AOR: 0.39; 95% CI: 0.32-0.47).

Conclusion: Predicting trauma patients with increased odds of leaving AMA will inform intentional communication that may reduce leaving AMA rates and improve care.

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References

Tsai T, Orav E, Jha A . Care fragmentation in the postdischarge period: surgical readmissions, distance of travel, and postoperative mortality. JAMA Surg. 2014; 150(1):59-64. DOI: 10.1001/jamasurg.2014.2071. View

Haines K, Freeman J, Vastaas C, Rust C, Cox C, Kasotakis G . "I'm Leaving": Factors That Impact Against Medical Advice Disposition Post-Trauma. J Emerg Med. 2020; 58(4):691-697. DOI: 10.1016/j.jemermed.2019.12.023. View

Lee C, Cho J, Choi S, Kim H, Park J . Patients who leave the emergency department against medical advice. Clin Exp Emerg Med. 2016; 3(2):88-94. PMC: 5051605. DOI: 10.15441/ceem.15.015. View

Paul G, Gautam P, Mahajan R, Gautam N, Ragavaiah S . Patients Leaving Against Medical Advice-A National Survey. Indian J Crit Care Med. 2019; 23(3):143-148. PMC: 6487628. DOI: 10.5005/jp-journals-10071-23138. View

Kraut A, Fransoo R, Olafson K, Ramsey C, Yogendran M, Garland A . A population-based analysis of leaving the hospital against medical advice: incidence and associated variables. BMC Health Serv Res. 2013; 13:415. PMC: 3853686. DOI: 10.1186/1472-6963-13-415. View

Jerrard D, Chasm R . Patients leaving against medical advice (AMA) from the emergency department--disease prevalence and willingness to return. J Emerg Med. 2010; 41(4):412-7. DOI: 10.1016/j.jemermed.2009.10.022. View

Quinlan W, Majoros N . Patients leaving against medical advice: assessing the liability risk. J Healthc Risk Manag. 1993; 13(1):19-22. DOI: 10.1002/jhrm.5600130106. View

Yuan S, Ashmore S, Chaudhary K, Hsu B, Puumala S . The Role of Socioeconomic Status in Individuals that Leave Against Medical Advice. S D Med. 2018; 71(5):214-219. View

Armenian S, Chutuape M, Stitzer M . Predictors of discharges against medical advice from a short-term hospital detoxification unit. Drug Alcohol Depend. 1999; 56(1):1-8. DOI: 10.1016/s0376-8716(99)00027-7. View

10.

Jasperse N, Grigorian A, Delaplain P, Jutric Z, Schubl S, Kuza C . Predictors of discharge against medical advice in adult trauma patients. Surgeon. 2019; 18(1):12-18. DOI: 10.1016/j.surge.2019.04.001. View

11.

Hasan O, Samad M, Khan H, Sarfraz M, Noordin S, Ahmad T . Leaving Against Medical Advice From In-patients Departments Rate, Reasons and Predicting Risk Factors for Re-visiting Hospital Retrospective Cohort From a Tertiary Care Hospital. Int J Health Policy Manag. 2019; 8(8):474-479. PMC: 6706961. DOI: 10.15171/ijhpm.2019.26. View

12.

Lekas H, Alfandre D, Gordon P, Harwood K, Yin M . The role of patient-provider interactions: Using an accounts framework to explain hospital discharges against medical advice. Soc Sci Med. 2016; 156:106-13. DOI: 10.1016/j.socscimed.2016.03.018. View

13.

Southern W, Nahvi S, Arnsten J . Increased risk of mortality and readmission among patients discharged against medical advice. Am J Med. 2012; 125(6):594-602. PMC: 3372411. DOI: 10.1016/j.amjmed.2011.12.017. View

14.

Rohr R . Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009; 361(3):311-2. View

15.

Ibrahim S, Kwoh C, Krishnan E . Factors associated with patients who leave acute-care hospitals against medical advice. Am J Public Health. 2007; 97(12):2204-8. PMC: 2089112. DOI: 10.2105/AJPH.2006.100164. View

16.

Gautam N, Sharma J, Sharma A, Verma V, Arora P, Gautam P . Retrospective Evaluation of Patients Who Leave against Medical Advice in a Tertiary Teaching Care Institute. Indian J Crit Care Med. 2018; 22(8):591-596. PMC: 6108296. DOI: 10.4103/ijccm.IJCCM_375_17. View

17.

Arif A, Adeyemi O . The Prevalence of Chronic Diseases Among Current and Ex-Miners in the United States. J Occup Environ Med. 2020; 62(3):227-231. DOI: 10.1097/JOM.0000000000001809. View

18.

Wilper A, Woolhandler S, Lasser K, McCormick D, Cutrona S, Bor D . Waits to see an emergency department physician: U.S. trends and predictors, 1997-2004. Health Aff (Millwood). 2008; 27(2):w84-95. DOI: 10.1377/hlthaff.27.2.w84. View

19.

Olufajo O, Metcalfe D, Yorkgitis B, Cooper Z, Askari R, Havens J . Whatever happens to trauma patients who leave against medical advice?. Am J Surg. 2016; 211(4):677-83. DOI: 10.1016/j.amjsurg.2015.11.016. View

20.

Bahadori M, Raadabadi M, Salimi M, Ravangard R . Discharge against medical advice: a case study in a public teaching hospital in Tehran, Iran in 2012. Glob J Health Sci. 2013; 5(6):179-85. PMC: 4776885. DOI: 10.5539/gjhs.v5n6p179. View