Associations of Mental, and Medical Illnesses With Against Medical Advice discharges: The National Hospital Discharge Survey, 1988–2006

Abstract

This study examined the association of mental and medical illnesses with the odds for leaving against medical advice (AMA) in a national sample of adult patients who left general hospitals between 1988 and 2006. Leaving AMA was first examined as a function of year and mental illness. Multiple logistic regression analysis was then used to adjust for patient and hospital characteristics when associating mental and major medical diagnoses with AMA discharges. The results indicated that leaving AMA was most strongly associated with mental health problems. However, the impact of mental illness was attenuated after adjusting for medical illnesses, patient and hospital characteristics. The strongest predictors of AMA discharge included being self-pay, having Medicaid insurance, being young and male, and the regional location of the hospital (Northeast). When substance abuse conditions were excluded from the mental illness discharge diagnoses, mental illness had lower odds for leaving AMA. The results may be of value to clinicians, and hospital administrators in helping to profile and target patients at risk for treatment-compliance problems. Prospective primary data collection that would include patient, physician, and hospital variables is recommended.

Understanding Patterns Of High-Cost Health Care Use Across Different Substance User Groups

“…19,20 Importantly, substance use disorders appear to affect health care costs even after increased disease burden is accounted for. 21 …”

A population-based analysis of leaving the hospital against medical advice: incidence and associated variables

“…The variable having the strongest reported association with leaving AMA is having done so before [5,6,9,10]. Other variables associated with leaving AMA have been younger age, male sex, membership in a visible minority, lower socioeconomic status, absence of health insurance, substance abuse, psychiatric disorders, and urban residency [1-7,9-17]. …”

“…The major limitations of the existing studies on leaving AMA are that most were based on localized experiences with limited numbers and follow-up, [5,6,10,14,20] were limited to one type of admission diagnosis,[4,7,9,12,13,16,17,19],[20] or were not population based [1,3]. Many studies also did not adjust for confounding variables.…”

Hospitalized Pregnant Women Who Leave Against Medical Advice: Attributes and Reasons

“…Socio-demographic variables consistently identified as predictors of DAMA include lower socioeconomic status, male sex, younger age, lack of insurance, substance abuse and race [11,12]. Some hospital factors contributing to DAMA include hospital size (defined by the number of beds), teaching and non-teaching environment of hospital, shorter hospital stay and the regional location of the hospital [2,13].…”