Factors Associated With Patients Who Leave Acute-Care Hospitals Against Medical Advice
- 1 December 2007
- journal article
- Published by American Public Health Association in American Journal of Public Health
- Vol. 97 (12), 2204-2208
- https://doi.org/10.2105/ajph.2006.100164
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.Keywords
This publication has 21 references indexed in Scilit:
- HIV-Positive Injection Drug Users Who Leave the Hospital Against Medical AdviceJAIDS Journal of Acquired Immune Deficiency Syndromes, 2004
- Effect of Patient Socioeconomic Status on Physician Profiles for Prevention, Disease Management, and Diagnostic Testing CostsMedical Care, 2002
- The impact of leaving against medical advice on hospital resource utilizationJournal of General Internal Medicine, 2000
- Patients discharged against medical advice from a general medicine serviceJournal of General Internal Medicine, 1998
- Who leaves against medical advice?Journal of General Internal Medicine, 1995
- Discharges against medical advice at regional acute care hospitals.American Journal of Public Health, 1991
- Security measures for AIDS and HIV.American Journal of Public Health, 1991
- Leaving a county hospital against medical adviceJAMA, 1979
- Signouts against medical advice from a coronary care unitJournal of Behavioral Medicine, 1979
- Diagnostic Correlates of Discharge Against Medical AdviceArchives of General Psychiatry, 1977