title: "I'm going home": discharges against medical advice.
abstract: 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.
authors.affiliation: Department of Veterans Affairs National Center for Ethics in Health Care, 423 E 23rd St (10E), New York, NY 10021, USA. david.alfandre@va.gov
authors.forename: David J
authors.initials: DJ
authors.lastname: Alfandre
mesh_terms: D000367:Age Factors; D003142:Communication; D006801:Humans; D007258:Informed Consent; D008484:Medicaid; D017057:Medically Uninsured; D009042:Motivation; D010351:Patient Discharge; D010817:Physician-Patient Relations; D012737:Sex Factors; D013315:Stress, Psychological / Q000150:complications; D019966:Substance-Related Disorders / Q000453:epidemiology; D016312:Treatment Refusal; D014481:United States