Said A. Ibrahim ^1*, C. Kent Kwoh ¹, Eswar Krishnan ²

¹ VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion
² Division of Rheumatology and Clinical Immunology at the University of Pittsburgh, School of Medicine

^* To whom correspondence should be addressed. E-mail: said.ibrahim2{at}med.va.gov.

	Abstract

Objectives. We examined hospital- and patient-related factors associated with discharge against medical advice (termed self-discharge) after emergency admission to acute-care hospitals.

Methods. We analyzed data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project using logistic regression models to assess the relationship between self-discharge and a set of patient and hospital characteristics.

Results. Of 3039050 discharges in the sample, 43 678 were against medical advice (1.44%). In multivariable modeling, predictors of self-discharge included having Medicaid insurance (adjusted odds ratio [AOR]=3.32; 95% confidence interval [CI]=3.22, 3.42), having Medicare insurance (AOR=1.64; 95% CI=1.59, 1.70), urban location (AOR=1.66; 95% CI=1.61, 1.72), medium (AOR=1.25; 95% CI=1.20, 1.29) or large (AOR=1.08, 95% CI=1.05, 1.12) hospital (defined by the number of beds), shorter hospital stay (OR=0.84; 95% CI=0.84, 0.85), and African American race (AOR=1.10; 95% CI=1.07, 1.14). Teaching hospitals had fewer self-discharges (AOR=0.90; 95% CI=0.88, 0.92). Other predictors of discharge against medical advice included age, gender, and income.

Conclusions. Approximately 1 in 70 hospital discharges in the United States were against medical advice. Both hospital and patient characteristics were associated with these decisions.

Key Words: Health Administration, Health Care Facilities/Services, Quality of Care, Race/Ethnicity