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Discharges against medical advice: Are race/ethnicity predictors?

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Abstract

BACKGROUND: Prior literature suggests that blacks are more likely to be discharged against medical advice (DAMA).

OBJECTIVE: We examined whether DAMA from general hospitals varies by race/ethnicity and whether this variation is explained by individual and hospital factors.

DESIGN, SUBJECTS, AND MEASUREMENTS: We conducted cross-sectional analyses of 1998 to 2000 hospital discharge data, linked to the American Hospital Association data, on adults admitted for acute general hospital care in California, Florida, and New York. A series of hierarchical logistic regression analyses explored factors associated with DAMA, initially adjusting for age and gender, then sequentially adding adjustment for comorbidities, individual socio-economic factors, and finally hospital characteristics.

RESULTS: Compared with whites, blacks had a 2-fold higher age-gender adjusted odds of DAMA, a risk that progressively diminished with increasing adjustment (final adjusted odds ratio [OR]=0.95, 95% confidence interval [CI]=0.91, 1.00). While Hispanics had an increased risk of DAMA in age-gender-adjusted analyses, the final model revealed a protective effect (adjusted OR=0.66, 95% CI=0.62, 0.70), similar to that observed for Asians.

CONCLUSIONS: Disparities in DAMA affecting minority patients in general hospitals are largely accounted for by individual and hospital socio-economic factors. The absence of any adjusted disparity affecting blacks, and the protective effect observed for Hispanics and other minorities suggest that individual discrimination and poor communication are not primary determinants of DAMA, but where patients are admitted does contribute to disparities in DAMA.

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Authors and Affiliations

  1. Center for Health Services Research in Primary Care, Department of Family & Community Medicine, University of California at Davis, California, 4860 Y Street, Suite 2300, 95817, Sacramento, CA

    Peter Franks MD

  2. Department of Family Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA

    Sean Meldrum MS

  3. Departments of Family Medicine and Community & Preventive Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA

    Kevin Fiscella MD, MPH

Authors
  1. Peter Franks MD
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  2. Sean Meldrum MS
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  3. Kevin Fiscella MD, MPH
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Correspondence to Peter Franks MD.

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None of the authors have a conflict of interest involving any material included in the manuscript.

The study was supported by funding through the Agency for Healthcare Research and Quality (R01 HS 10910-01A2).

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Franks, P., Meldrum, S. & Fiscella, K. Discharges against medical advice: Are race/ethnicity predictors?. J GEN INTERN MED 21, 955–960 (2006). https://doi.org/10.1007/BF02743144

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  • DOI: https://doi.org/10.1007/BF02743144

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