Number of patients leaving against advice increasing
Would it surprise you that the number of patients leaving a hospital against medical advice (AMA) increased 39% between 1997 and 2007? The number totaled 368,000 in 2007, says a new report from the Agency for Healthcare Research and Quality.1
According to the report, the top five diagnoses for patients leaving AMA in 2007 were: non-specific chest pain (7%); alcohol-related disorders (6.9%); substance-related disorders (5.7%); mood disorders (3.8%); and diabetes with complications (3.4%).
"Tracking AMAs by diagnosis is interesting," says Peter Kraus, CHAM, CPAR, business analyst with patient financial services at Emory University Hospital in Atlanta. "For three of the top five, the patient's mental state may be a contributing factor. The other two are diagnoses the patient may be living and coping with over a period of time. Symptoms fade, the patient feels better and doesn't want to stay, even though it might be more sound medically to do additional testing or treatments."
A significant percentage (22%) of the patients who left AMA were uninsured. In light of this, Kraus says that one concern is that if an emergency department patient leaves AMA, access could be suspected of screening patients financially prior to triage in violation of the Emergency Medical Treatment and Labor Act. Another possibility is that some of the AMA patients might have chosen to stay and be treated if they had qualified for financial assistance or public programs. "If self-pay patients know that the hospital will help them qualify for financial assistance, they may be less fearful of running up a bill they can't pay," says Kraus.
Reference
1. Stranges E, Wier L, Merrill CT, et al. Hospitalizations in which patients leave the hospital against medical advice (AMA), 2007. Statistical Brief #78. Healthcare Cost and Utilization Project (HCUP). August 2009. Agency for Healthcare Research and Quality, Rockville, MD.
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