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Factors associated with patients who leave acute-care hospitals against medical advice

Author

Listed:
  • Ibrahim, S.A.
  • Kwoh, C.K.
  • Krishnan, E.

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 3039050 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.

Suggested Citation

  • Ibrahim, S.A. & Kwoh, C.K. & Krishnan, E., 2007. "Factors associated with patients who leave acute-care hospitals against medical advice," American Journal of Public Health, American Public Health Association, vol. 97(12), pages 2204-2208.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2006.100164_9
    DOI: 10.2105/AJPH.2006.100164
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    Cited by:

    1. Louise Sealy & Karen Zwi & Gordon McDonald & Aldo Saavedra & Lisa Crawford & Hasantha Gunasekera, 2019. "Predictors of Discharge Against Medical Advice in a Tertiary Paediatric Hospital," IJERPH, MDPI, vol. 16(8), pages 1-11, April.
    2. Rima Tawk & Matthew Dutton, 2015. "Racial Differences in Length of Stay for Patients Who Leave Against Medical Advice from U.S. General Hospitals," IJERPH, MDPI, vol. 13(1), pages 1-9, December.
    3. Pietro Giorgio Lovaglio, 2017. "Are quality indicators predictive of compensated injury claims?," Quality & Quantity: International Journal of Methodology, Springer, vol. 51(4), pages 1903-1919, July.
    4. Lekas, Helen-Maria & Alfandre, David & Gordon, Peter & Harwood, Katherine & Yin, Michael T., 2016. "The role of patient-provider interactions: Using an accounts framework to explain hospital discharges against medical advice," Social Science & Medicine, Elsevier, vol. 156(C), pages 106-113.

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