5 risk factors for hospital discharge against medical advice

When patients leave the hospital against physicians' advice, it puts them at greater risk for readmission, morbidity or death. Researchers set out to find common risk factors for discharges against medical advice and published their findings in the Journal of the American Geriatrics Society this month.

Jashvant Poeran, MD, PhD, with the Icahn School of Medicine at Mount Sinai in New York City, and his team analyzed data on more than 29 million hospital stays in the 2013 National Inpatient Sample.

They found older men and women were four times less likely to leave the hospital against medical advice than adults under 65 years old.

Other characteristics associated with higher risk of leaving the hospital against medical advice at any age are:

  • Being male
  • Being uninsured or insured by Medicaid
  • Having mental health concerns

Among older adults specifically, black people and low-income people were at 65 percent and 57 percent greater risk of discharge against medical advice, respectfully.

"One of the reasons mentioned in previous studies for leaving the hospital against medical advice is suboptimal communication, which may indeed affect older minority patients more," said Dr. Poeran. "More research is needed to find out why exactly race/ethnicity and poverty are more pronounced as risk factors in older patients, especially since Medicare theoretically offers universal health coverage for patients aged 65 years or older."

More articles on patient safety:
Study: Power differential keeps residents from reporting unprofessional physician behavior
Investigation: Understaffing in OR contributed to 2 patient deaths at California hospital
7 areas of concern for patient safety identified at Atlanta VA hospital

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