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.
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.
- Content Type Journal Article
- Category Research – Practice Relationships
- Pages 1-9
- DOI 10.1007/s10488-011-0382-8
- Authors
- Rima Tawk, Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60612, USA
- Sally Freels, Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60612, USA
- Ross Mullner, Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60612, USA
- Journal Administration and Policy in Mental Health and Mental Health Services Research
- Online ISSN 1573-3289
- Print ISSN 0894-587X