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Open Access Highly Accessed Research article

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

Allen Kraut12*, Randy Fransoo23, Kendiss Olafson1, Clare D Ramsey12, Marina Yogendran3 and Allan Garland123

Author Affiliations

1 Department of Internal Medicine, University of Manitoba Winnipeg, Manitoba, Canada

2 Department of Community Health Sciences, University of Manitoba Winnipeg, Manitoba, Canada

3 Manitoba Centre for Health Policy, University of Manitoba Winnipeg, Manitoba, Canada

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BMC Health Services Research 2013, 13:415  doi:10.1186/1472-6963-13-415

Published: 14 October 2013

Abstract

Background

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.

Methods

We 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.

Results

Of 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.

Conclusions

The 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.

Keywords:
Against medical advice; Epidemiology; Canada; Population based