Abstract
There is a paucity of published literature on the length of hospital stays (LOS) for patients who leave against medical advice (AMA) and on the factors that predict their LOS. The purpose of the study is to examine the relationship between race and the LOS for AMA patients after adjusting for patient and hospital characteristics. National Hospital Discharge Survey (NHDS) data were used to describe LOS for AMA patients aged 18 years or older. Patient characteristics included age, sex, race, marital status, insurance, and diagnosis (ICD-9-CM). Hospital characteristics consisted of ownership, region and bed size. LOS was the major outcome measure. Using data from all years 1988–2006, the expected time to AMA discharge was first examined as a function of race, then adjusting for year terms, patient and hospital characteristics, and major medical diagnoses and mental illness. The unadjusted effect of race on the expected time of leaving AMA was about twice the adjusted effect. After controlling for the other covariates, the expected time to AMA discharge is 20% shorter for Blacks than Whites. The most significant predictors included age, insurance coverage, mental illness, gender, and region. Factors identified in this study offer insights into directions for evidence based- health policy to reduce AMA discharges.
Highlights
Against Medical Advice (AMA) discharge occurs when a patient decides to leave the hospital before the physician has recommended discharge
In the previous studies that examined race, most [3,4,5,6,7,8,9] but not all [10,11], studies have found that African American patients have an increased risk of AMA discharges compared with white patients
The literature suggests that the relationship between race and AMA discharge could reflect the known association between lower socioeconomic status and AMA discharge [3,8,11,12]
Summary
Against Medical Advice (AMA) discharge occurs when a patient decides to leave the hospital before the physician has recommended discharge. A review of the literature revealed numerous articles over the last four decades concerned with rates, patient characteristics, and predictive factors. An obvious feature is the great variation seen depending upon medical conditions, patient populations, and type of treatment settings [1,2]. Male gender, insurance status, personality disorders, and substance abuse have been the most consistent characteristics shared by patients discharged AMA from general hospitals [3,4]. The literature suggests that the relationship between race and AMA discharge could reflect the known association between lower socioeconomic status and AMA discharge [3,8,11,12]
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