Discharge against medical advice

Accounts for approximately 1 to 2% of all hospital discharges in the US.

Compared with conventional discharges patients who leave against medical advice are likely to leave with deficient care, increasing the risk of hospital readmission, morbidity, and mortality.

Discharge AMA imposes increased burden on the healthcare system by its disruption of patient care, increased consumption of resources, and challenges to providers ethical obligations.

Discharge AMA heightened medical risks for patients and legal risk for physicians and hospitals.

Discharge AMA highest rates among patients who are younger, male, black, of low income, and uninsured,among those with underlying psychiatric disorders, and among those with comorbid alcohol abuse.

Discharge AMA patients are often of lower socioeconomic status, lack insurance coverage, and have untreated substance use disorders.

Higher rates of discharge AMA observed in Medicare/Medicaid recipients and those hospitalized with mental health and substance abuse disorders.

Higher rates are observed in urban hospitals and Northeast region of the US.

Generally arises from lack of communication at the physician-patient level.

Factors affecting communication include age, sex, race/ethnicity, income status, and insurance status.

Younger age is a risk factor for discharge AMA.

Discharged AMA patients have a higher risk of morbidity and mortality after discharge.

Discharged AMA patients is associated with twice the odds of 30 day readmission compared with routine discharge.

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