Leaving Against Medical Advice From Children's Hospitals

Area of Science:

• Pediatric Health Services Research
• Health Equity in Inpatient Care
• Patient Discharge Studies

Background:

• Leaving hospital against medical advice (AMA) signifies a critical breakdown in the family-clinician relationship within pediatric inpatient settings.
• Ethical dilemmas arise from AMA discharges in pediatric care.
• National data on the frequency and characteristics of AMA discharges in U.S. children's hospitals are lacking.

Purpose of the Study:

• To determine the national frequency and characteristics of children leaving the hospital against medical advice (AMA).
• To identify demographic, geographic, and clinical factors associated with AMA discharges in pediatric patients.
• To examine the association between AMA discharges and subsequent hospital readmission in children.

Main Methods:

• A retrospective cohort study analyzed 3,672,243 inpatient encounters for children under 18 across 43 U.S. children's hospitals from 2018-2022.
• Data were sourced from the Pediatric Health Information System (PHIS) database.
• Multivariable mixed-effects logistic regression models assessed factors associated with leaving AMA and 14-day all-cause hospital readmission.

Main Results:

• Approximately 0.08% (2,972/3,672,243) of pediatric inpatient encounters resulted in leaving AMA.
• Non-Hispanic Black patients exhibited higher odds of leaving AMA (aOR 1.31) compared to non-Hispanic white patients.
• Patients with noncommercial insurance had higher odds of AMA discharge, which was associated with increased 14-day readmission risk (aOR 1.41).
• Significant interhospital variability in AMA discharge rates was observed.

Conclusions:

• Leaving the hospital against medical advice (AMA) occurred in approximately 1 in 1235 pediatric inpatient encounters.
• Non-Hispanic Black children faced increased odds of AMA discharges.
• AMA discharges were significantly associated with a higher likelihood of 14-day hospital readmission.