Are more patients leaving the hospital against medical advice?

by Michael Smith, North American Correspondent, MedPage Today

The number of people who check out of hospitals against medical advice has grown dramatically, according to the Agency for Healthcare Research and Quality.

In 2007, the agency said, inpatient care ended that way 368,000 times, accounting for 1.2% of all hospital stays, compared with only 264,000 such discharges a decade earlier.

That 39% increase is markedly higher than the 13% increase in all other hospital stays during the period from 1997 through 2007, the agency noted in a statistical brief.

The finding is based on data from the agency’s Healthcare Cost and Utilization Project 2007 Nationwide Inpatient Sample.

On average, hospital stays that ended in discharge against medical advice were about 2.7 days (versus 5.1 days for all other stays) and cost about $5,300 (versus $10,400).

The chief reason for care in such cases was nonspecific chest pain, accounting for 7% of the total. But alcohol-related disorders, substance-related disorders, and mood disorders taken together accounted for more than twice as many cases (6.9%, 5.7%, and 3.8% of the total, respectively.)

People who left hospital against medical advice were disproportionately uninsured or on Medicaid, the agency found. Of the total, 21.7% were uninsured and 27.3% were on Medicaid, compared with only 5.9% and 11.7% of all other hospital stays, respectively.

The data also show that people who left hospital against medical advice were more likely to be:

* Male: Men left hospital against advice at a rate of 1.5 per 1,000 population, compared with 0.9 for 1,000 women. In contrast, women were more likely to be inpatients, at a rate of 102.8 per 1,000, compared with 91.5 for men.

* Younger than other patients: The average age those who left against advice was 46 years, compared with 58 years for all other inpatients.

* Urban dwellers: Patients in those areas were nearly twice as likely to leave hospital against advice than patients living in all other areas — 1.8 per 1,000 population, compared with about 1.0.

* Poorer than other inpatients: Overall, inpatient care rates were 1.5 times greater in the poorest communities than in the wealthiest areas, but the magnitude of difference was greater among those who left against advice — 2.7 times higher among those in the poorest communities than in the wealthiest areas.