Abstract
BackgroundPrior studies of patients leaving hospital against medical advice (AMA) have been limited by not being population-based or assessing only one type of patient.MethodsWe used administrative data at the Manitoba Centre for Health Policy to evaluate all adult residents of Manitoba, Canada discharged alive from acute care hospitals between April 1, 1990 and February 28, 2009. We identified the rate of leaving AMA, and used multivariable logistic regression to identify socio-demographic and diagnostic variables associated with leaving AMA.ResultsOf 1 916 104 live hospital discharges, 21 417 (1.11%) ended with the patient leaving AMA. The cohort contained 610 187 individuals, of whom 12 588 (2.06%) left AMA once and another 2 986 (0.49%) left AMA more than once. The proportion of AMA discharges did not change over time. Alcohol and drug abuse was the diagnostic group with the highest proportion of AMA discharges, at 11.71%. Having left AMA previously had the strongest association with leaving AMA (odds ratio 170, 95% confidence interval 156–185). Leaving AMA was more common among men, those with lower average household incomes, histories of alcohol or drug abuse or HIV/AIDS. Major surgical procedures were associated with a much lower chance of leaving the hospital AMA.ConclusionsThe rate of leaving hospital AMA did not systematically change over time, but did vary based on patient and illness characteristics. Having left AMA in the past was highly predictive of subsequent AMA events.
Highlights
Prior studies of patients leaving hospital against medical advice (AMA) have been limited by not being population-based or assessing only one type of patient
We identified 1 916 104 hospital episodes in which patients were discharged alive during the 19 year study period, of which 21 417 (1.11%) ended with the patient leaving hospital AMA
There was a marked decline in yearly hospital episodes over time, while the percentage of episodes ending with patients leaving AMA fluctuated in an undulating pattern (Figure 1)
Summary
Prior studies of patients leaving hospital against medical advice (AMA) have been limited by not being population-based or assessing only one type of patient. Between 1 – 2% of hospitalized patients [1,2,3,4] leave hospital against medical advice (AMA). We have recently shown using a large population based dataset, that leaving AMA is associated with increased hospital readmissions and mortality at all times up to 180 days post discharge [18] building on limited previous work [4,9,14,19]. The objective of this research was to address these limitations by utilizing a large, population-based data system containing comprehensive information about patients, their diseases, and their hospitalizations to identify variables independently associated with leaving hospital AMA
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