"I'm Going Home": Discharges Against Medical Advice

Alfandre, David J.
March 2009
Mayo Clinic Proceedings;Mar2009, Vol. 84 Issue 3, p255
Academic Journal
Discharge against medical advice (AMA), in which a patient chooses to leave the hospital before the treating physician recommends discharge, continues to be a common and vexing problem. This article reviews the prevalence, costs, predictors, and potential interventions for this clinical problem. Between 1% and 2% of all medical admissions result in an AMA discharge. Predictors of AMA discharge, based primarily on retrospective cohort studies, tended to be younger age, Medicaid or no insurance, male sex, and current or a history of substance or alcohol abuse. Interventions to reduce the rate of AMA discharges have not been systematically studied. This article offers suggestions for interventions based on studies in other areas of clinical care as well as the psychiatric AMA discharge literature. Studies for this review were identified by searching the relevant MeSH heading (discharge) and key words (against medical advice, leave, elope, hospital, and self-discharge) in PubMed databases and selecting all English- language articles from 1970 through 2008 that included data on adult medical inpatients.


Related Articles

  • 'Present on admission' rule effective Jan. 2008. Smith, Jeffrey // Hospital Access Management;Nov2007, Vol. 26 Issue 11, p124 

    The article discusses the requirement of the U.S. Centers for Medicare & Medicaid Services (CMS) for the completion of a present on admission (POA) indicator which will be effective in January 2008. It highlights the importance of diagnosis delineation, source documentation and follow-up...

  • An Evaluation of a Hospital Stay Regulatory Mechanism. Lave, Judith R.; Leinhardt, Samuel // American Journal of Public Health;Oct76, Vol. 66 Issue 10, p959 

    The results of an evaluation of a pre-discharge utilization review program [PDUR] for Medicaid Patients are presented. A group of hospitals in Allegheny County, Pennsylvania, participated in this program on a voluntary basis prior to the program's being mandated statewide. All other hospitals in...

  • The Effect of Reimbursement on the Intensity of Hospital Services. Lindrooth, Richard C.; Bazzoli, Gloria J.; Clement, Jan // Southern Economic Journal;Jan2007, Vol. 73 Issue 3, p575 

    We examine how hospital treatment intensity is affected by an exogenous change in average reimbursement for an admission. Theory predicts that treatment intensity would be most affected for highly profitable services but unaffected for unprofitable services. We use Medicare inpatient data from...

  • Erosion in the Healthcare Safety Net: Impacts on Different Population Groups. Mobley, Lee; Tzy-Mey Kuo; Bazzoli, Gloria J. // Open Health Services & Policy Journal;2011, Vol. 4, p1 

    Safety net hospitals (SNHs) have played a critical role in the U.S. health system providing access to health care for vulnerable populations, in particular the Medicaid and uninsured populations. However, little research has examined how access for these populations changes when contraction of...

  • Research on the Hospital Market: Recent Advances and Continuing Data Needs. Lindrooth, Richard C. // Inquiry (00469580);Spring2008, Vol. 45 Issue 1, p19 

    Research focused on the hospital market has been instrumental in furthering our understanding of the role of competition in health care. Such research would not have been conducted without the extensive public use data that have been made available to researchers. In particular, path-breaking...

  • Hospital Length of Stay.  // Revenue Cycle Strategist;Jan2008, p4 

    The article focuses on the average length of stay (LOS) for hospital discharges of all ages in the U.S. According to the author, LOS have declined and was significantly shorter in 2005 compared in 1970. Several factors exerted pressure on LOS, including the shift in Medicare payment for...

  • Risk of Death for Medicaid Recipients Undergoing Congenital Heart Surgery. DeMone, J.A.; Gonzalez, P.C.; Gauvreau, K.; Piercey, G.E.; Jenkins, K.J. // Pediatric Cardiology;Mar2003, Vol. 24 Issue 2, p97 

    The objective of this study was to explore the effect of insurance type on mortality for congenital heart surgery. We performed a population-based retrospective cohort study using hospital discharge abstract data from five states in 1992 and 1996. The outcome measure was risk-adjusted...

  • omission of procedure codes has significant impact on Medicare payment.  // hfm (Healthcare Financial Management);Oct2005, Vol. 59 Issue 10, p138 

    The article focuses on inpatient hospital admissions being processed without a primary ICD-9 procedure code in the United States according to Medicare Provider Analysis and Review data. Hospitals need to make sure that all Medicare admissions are properly documented to receive the right payment...

  • admissions and payments rise due to nontraditional Medicare patients.  // hfm (Healthcare Financial Management);Jan2006, Vol. 60 Issue 1, p126 

    The article reports on the increase in inpatient hospital admissions and payments processed by the Medicare program in the U.S. Nontraditional beneficiaries account for an increasing percentage of the total admissions processed and payments paid by the Medicare Part A program. A comparison of...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics