Patients leaving against medical advice 2.5 times more likely to die

Risk of readmission within 30 days triples
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Leaving the hospital against medical advice more than doubles a patient's risk of dying within 90 days, finds a large, nearly two-decade study published in the Canadian Medical Association Journal (CMAJ).

Patients leaving against medical advice also are three times as likely to be readmitted within 30 days, according to a CMAJ announcement describing the findings.

Researchers looked at more than 1.9 million adult admissions and discharges over almost 20 years to make their determinations. About 1.1 percent (21,417) of patients left the hospital against medical advice.

Among the 30-day readmissions, 25 percent were rehospitalized within a day, and the rest within two weeks, according to the announcement. Older, low-income men with multiple admissions in the preceding five years were more likely to be readmitted, the study found.

The death rate within 90 days for those leaving against medical advice was 2.5 times higher than for all patients.

"For both hospital readmission and death, the elevated rates among patients who left against medical advice started out high and then declined, but remained elevated to at least 180 days," write the authors.

The data suggest the higher risk comes from a combination of the illness for which they were treated as well as behaviors including failure to follow medical advice or take medication as directed, according to the findings.

"The persistence of these effects suggests that they are not solely a result of incomplete treatment of acute illness," according to the study abstract. "Interventions aimed at reducing these effects may need to include longitudinal interventions extending beyond admission to hospital."

A smaller study published last year in the American Journal of Medicine found patients leaving against medical advice were twice as likely to die. It was the first study to prove association between leaving against advice and a higher risk of death, William N. Southern, hospital medicine chief of New York's Albert Einstein College of Medicine and Montefiore Medical Center, told Reuters Health at the time.

"Our findings suggest that whatever your baseline (death) risk is--whether it's high or low--it would be twice as high if you leave the hospital against medical advice," Southern said, suggesting the problem may be a failure to receive follow-up care.

For more information:
- here's the study abstract
- read the announcement
- check out last year's AJM study

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