Background: Discharges against medical advice (AMA) account for 0.8-2.2% of all national discharges and represents an extreme in non-compliance. Patients who elect to leave AMA have increased rates of mortality, morbidity and readmission rates. Literature on this topic, to date, has focused on AMA in the context of specific admitting diagnoses or discharges from certain departments within a hospital. Few studies have examined this at the institutional level. This study aims to address this by examining AMA discharges at a large tertiary care hospital, attempting to 1)quantify the number of AMA discharges over a 12 month period 2) determine variables prominent in the AMA population and 3) evaluate outcomes associated with AMA discharges.

Methods: Using an automated search query of the hospital system’s electronic medical record (EMR), a list of all discharges from any adult inpatient services over a twelve month span was produced. This produced 46 958 unique medical record numbers, each corresponding to a patient. A second automated query of all these patients charts was done for the hospital admission in question for the terms “AMA” or “Against Medical Advice”. This produced unique medical record numbers that would compose the study population.

Results: Aim 1) Quantify the number of AMA discharges over a 12 month period at a large tertiary care hospital (one of the largest in America):- Of 46,998 discharges, 0.85% occurred AMA, translating to 400 patients. Aim 2) Determine demographics prominent in AMA discharges:- Risk factors that were identified to have a statistically significant higher rate of discharge AMA (p<0.005) were; young age, male sex, African American race, Medicaid/Medicare insurance or uninsured, those admitted over the weekend and those admitted with chronic conditions or mental health diagnoses.Aim 3) Evaluate outcomes associated with AMA discharges:- AMA discharges patients have a significantly higher odds of being readmitted at each time point examined up to 60-days from discharge.

Conclusions: This study provides further information regarding the demographics of those who elect to leave AMA at the institutional level and the outcomes from this decision. Identifying who is at risk for leaving AMA may help to profile and target patients at high risk for treatment non-compliance and identify strategies to decrease AMA discharges and improve health outcomes.

IMAGE 1: Multivariate analysis of statistically significant factors of AMA discharges

IMAGE 2: Readmission rates of AMA discharges