title: Associations of mental, and medical illnesses with against medical advice discharges: the National Hospital Discharge Survey, 1988-2006.
abstract: This study examined the association of mental and medical illnesses with the odds for leaving against medical advice (AMA) in a national sample of adult patients who left general hospitals between 1988 and 2006. Leaving AMA was first examined as a function of year and mental illness. Multiple logistic regression analysis was then used to adjust for patient and hospital characteristics when associating mental and major medical diagnoses with AMA discharges. The results indicated that leaving AMA was most strongly associated with mental health problems. However, the impact of mental illness was attenuated after adjusting for medical illnesses, patient and hospital characteristics. The strongest predictors of AMA discharge included being self-pay, having Medicaid insurance, being young and male, and the regional location of the hospital (Northeast). When substance abuse conditions were excluded from the mental illness discharge diagnoses, mental illness had lower odds for leaving AMA. The results may be of value to clinicians, and hospital administrators in helping to profile and target patients at risk for treatment-compliance problems. Prospective primary data collection that would include patient, physician, and hospital variables is recommended.
authors: Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60612, USA. rtawk1@uic.edu
authors: Rima
authors: R
authors: Tawk
authors: Sally
authors: S
authors: Freels
authors: Ross
authors: R
authors: Mullner
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult