Risk Factors for Leaving Against Medical Advice in Patients Admitted for Upper Extremity Orthopedic Procedures

Overview

Journal J Am Acad Orthop Surg Glob Res Rev

Specialty Orthopedics

Date 2024 Jun 7

PMID 38848462

Authors

David Momtaz

Umar Ghilzai

Shawn Okpara

Abdullah Ghali

Rishi Gonuguntla

Travis Kotzur

Kai Zhu

Ali Seifi

Ryan Rose

Affiliations

Soon will be listed here.

Abstract

Introduction: Patients who leave against medical advice (AMA) face increased risks of negative health outcomes, presenting a challenge for healthcare systems. This study examines demographic and hospital course factors associated with patients leaving AMA after an upper extremity (UE) orthopaedic procedure.

Methods: We analyzed 262,912 patients who underwent UE orthopaedic procedures between 2011 and 2020, using the Healthcare Cost and Utilization Project database. We then compared demographic and hospital course factors between patients who left AMA and those who did not leave AMA.

Results: Of 262,912 UE orthopaedic patients, 0.45% (1,173) left AMA. Those more likely to leave AMA were aged 30 to 49 (OR, 5.953, P < 0.001), Black (OR, 1.708, P < 0.001), had Medicaid (OR, 3.436, P < 0.001), and were in the 1st to 25th income percentile (OR, 1.657, P < 0.001). Female patients were less likely to leave AMA than male patients (OR, 0.647, P < 0.001). Patients leaving AMA had longer stays (3.626 versus 2.363 days, P < 0.001) and longer recovery times (2.733 versus 1.977, P < 0.001).

Conclusion: We found that male, Black, younger than 49 years old, Medicaid-insured, and lowest income quartile patients are more likely to leave AMA after UE orthopaedic treatment.

References

de Putter C, Selles R, Haagsma J, Polinder S, Panneman M, Hovius S . Health-related quality of life after upper extremity injuries and predictors for suboptimal outcome. Injury. 2014; 45(11):1752-8. DOI: 10.1016/j.injury.2014.07.016. View

Spooner K, Salemi J, Salihu H, Zoorob R . Discharge Against Medical Advice in the United States, 2002-2011. Mayo Clin Proc. 2017; 92(4):525-535. DOI: 10.1016/j.mayocp.2016.12.022. 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

van Lieshout E, van de Port I, Dijkhuizen R, Visser-Meily J . Does upper limb strength play a prominent role in health-related quality of life in stroke patients discharged from inpatient rehabilitation?. Top Stroke Rehabil. 2020; 27(7):525-533. DOI: 10.1080/10749357.2020.1738662. View

MacDermid J, McClure J, Richard L, Faber K, Jaglal S . Fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures from population health data in Ontario. BMC Musculoskelet Disord. 2021; 22(1):996. PMC: 8630866. DOI: 10.1186/s12891-021-04849-7. 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

Franks P, Meldrum S, Fiscella K . Discharges against medical advice: are race/ethnicity predictors?. J Gen Intern Med. 2006; 21(9):955-60. PMC: 1831611. DOI: 10.1111/j.1525-1497.2006.00505.x. View

Blatt B, LeLacheur S, Galinsky A, Simmens S, Greenberg L . Does perspective-taking increase patient satisfaction in medical encounters?. Acad Med. 2010; 85(9):1445-52. DOI: 10.1097/ACM.0b013e3181eae5ec. View

Elizabeth Goldman L, Vittinghoff E, Dudley R . Quality of care in hospitals with a high percent of Medicaid patients. Med Care. 2007; 45(6):579-83. DOI: 10.1097/MLR.0b013e318041f723. View

10.

Kong L, Chen Y, Wang L, Wang K, Liu C, Gan Y . Effect of Perspective-Taking on Trust Between Doctors and Patients: A Randomized Controlled Trial. J Clin Psychol Med Settings. 2023; 30(4):708-715. PMC: 9902241. DOI: 10.1007/s10880-022-09935-z. View

11.

Inkellis E, Low E, Langhammer C, Morshed S . Incidence and Characterization of Major Upper-Extremity Amputations in the National Trauma Data Bank. JB JS Open Access. 2018; 3(2):e0038. PMC: 6145564. DOI: 10.2106/JBJS.OA.17.00038. View

12.

Martin K, Roter D, Beach M, Carson K, Cooper L . Physician communication behaviors and trust among black and white patients with hypertension. Med Care. 2012; 51(2):151-7. PMC: 3552122. DOI: 10.1097/MLR.0b013e31827632a2. View

13.

Moy E, Bartman B . Race and hospital discharge against medical advice. J Natl Med Assoc. 1996; 88(10):658-60. PMC: 2608118. View

14.

Bumbasirevic M, Stevanovic M, Lesic A, Atkinson H . Current management of the mangled upper extremity. Int Orthop. 2012; 36(11):2189-95. PMC: 3479293. DOI: 10.1007/s00264-012-1638-y. View

15.

Becker G, Newsom E . Socioeconomic status and dissatisfaction with health care among chronically ill African Americans. Am J Public Health. 2003; 93(5):742-8. PMC: 1447830. DOI: 10.2105/ajph.93.5.742. View

16.

Menendez M, van Dijk C, Ring D . Who leaves the hospital against medical advice in the orthopaedic setting?. Clin Orthop Relat Res. 2014; 473(3):1140-9. PMC: 4317430. DOI: 10.1007/s11999-014-3924-z. View

17.

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

18.

Holmes E, Cooley B, Fleisch S, Rosenstein D . Against Medical Advice Discharge: A Narrative Review and Recommendations for a Systematic Approach. Am J Med. 2021; 134(6):721-726. DOI: 10.1016/j.amjmed.2020.12.027. View