Patients Leaving California Hospitals Against Medical Advice (AMA)

In 2019, there were 38,161 discharges against medical advice in California, representing 3.2 percent of all discharges that year.

Patients leaving AMA is defined as choosing to leave the hospital before the treating physician recommends discharge. Patients who left California hospitals AMA in 2019 demonstrate more risk factors when compared to discharges as a whole, such as having substance abuse issues or no insurance. These patients are exposed to higher risks due to inadequately treated medical issues, which may result in the need for readmission. Patients having substance and alcohol abuse issues comprised nearly 19 percent of AMA discharges, but fewer than 6 percent of total discharges in 2019. In discharges amongst patients who left AMA more than once, this trend is even more pronounced.

Discharge counts can be compared side by side across three groups: total discharges, AMA discharges, and AMA discharges among patients leaving AMA more than once. The visualization can be filtered by six key categories: admission type, age, primary diagnosis, expected payer, race/ethnicity, and sex. 

Key Findings:#

  • Patients leaving AMA are much more likely to have a primary diagnosis related to disorders in substance and alcohol abuse, chronic obstructive pulmonary disease (COPD), nonspecific chest pain, and skin/tissue infections.
  • Septicemia and hypertension are the most common primary diagnosis codes among all discharges and remain a large proportion of AMA discharges.
  • Although Medicare patients comprise most of all discharges, Medi-Cal patients comprise a disproportionate majority of AMA discharges.
  • Younger patients are more likely than older patients to leave AMA, despite patients over 65 comprising the largest number of all discharges.
  • Males have demonstrated a greater likelihood to leave AMA when compared to females. This trend is more pronounced in patients leaving AMA more than once.
  • Patients leaving AMA more than once in 2019 represent 1.2 percent of all discharges and 0.5 percent of all patients.

Primary Diagnosis

The primary diagnosis uses Clinical Classifications Software (CCS). The CCS “clinical grouper” was developed by the Agency for Healthcare Research and Quality (AHRQ) as a tool for clustering patient diagnoses into a manageable number of clinically meaningful categories to make it easier to quickly understand diagnosis patterns.

The fifteen primary diagnoses used in the visualization represent the most common diagnoses present across all discharges as well as AMA discharges in 2019.

For more detail, please refer to the 2019 PDD Data Dictionary.

For assistance with finding this data, please contact us at dataandreports@oshpd.ca.gov.

Additional Information#

Topic: Patients Leaving California Hospitals Against Medical Advice (AMA)
Temporal Coverage: 2019
Spatial/Geographic Coverage: Statewide
Geographic Granularity: Statewide
Frequency: Annually
Source Link: Office of Statewide Health Planning and Development: Patient Discharge Data