Factors identified leading to hospital discharges against physician’s advice

Leaving the hospital against the advice of physicians is a rising trend with negative consequences. In an effort to understand why patients chose to leave hospital care early, researchers have published findings in the Journal of the American Geriatrics Society to assist in further research and provide answers on how healthcare providers can stop this trend.

Patients being discharged from the hospital on their own accord face higher risk for readmission, morbidity, mortality and higher costs. Despite these risks, rates of self-discharge are rising. This study aims to outline the factors associated with self-discharge including age, sex and medical access.

Led by Jashvant Poeran, MD, PhD, of the Icahn School of Medicine at Mount Sinai, researchers analyzed data on all U.S. hospitalizations. Of the 29 million hospital stays in the 2013 National Inpatient Sample, less than 50,000 were reported as self-discharges. With a focus on patients over 65, the study compared rates of self-discharge to patients ages 18-64.

Results included: 

• Patients over 65 were four times less likely to leave the hospital against physician advice for 18 to 64-year-old patients
• From 2003 to 2013 rates of self-discharge rose from 1.44 percent to 1.78 percent among patients aged 18-64 and from .347 percent to .42 percent in the over 65 group.
• In both age groups, men, patients insured by Medicaid or not insured and living with mental illness were more likely to leave the hospital against advice.
• In the over 65 group, African Americans were 65 percent more likely to leave the hospital and low- income patients were 57 percent more likely.

"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."

Researchers hope these findings begin additional researcher into factors effecting rates of self-discharge against medical devices and the differences in age groups.

 “The patients' social supports and functional and cognitive abilities were not measured in the original sample. Each of these could influence an older person's ability to leave the hospital against medical advice," said Rosanne Leipzig, MD, PhD, the study team's senior clinician. "This information will be important in order for hospitals and healthcare providers to address this issue."