Maternal and Child Health Journal

, Volume 11, Issue 5, pp 431–436 | Cite as

Post Partum Discharge Against Medical Advice: Who Leaves and Does it Matter?

Original Paper


Objective: To examine risk factors and sequela for post partum discharge against medical advice. Methods: We conducted cross-sectional analyses of hospital discharge data linked to American Hospital Association data for women discharged following a live birth for California, Florida, and New York in the years 1998–2000. We examined rates, risk factors, hospital readmission rate and mortality (California only), associated with discharge against medical advice after controlling for patient and hospital characteristics. Results: Post partum discharge against medical advice averaged 0.10%. Rates were lowest among women following uncomplicated cesarean and vaginal births (0.07%), intermediate following complicated vaginal birth (0.21%) and highest following complicated cesarean birth (0.29%). African American race, lower income, public health insurance, no health insurance, or greater comorbidity, particularly drug abuse or psychotic illness, discharge from a hospital in California or New York (compared to Florida), and location in medium or large metropolitan areas, were associated with significantly higher rates of discharge against advice. Asian or Hispanic race or ethnicity and delivery at an obstetrical specialized hospital were associated with lower risk. Patients discharged against medical advice in California were significantly more likely to be re-admitted within 30 days (adjusted odds ratio 2.7; 95% confidence interval [CI] 1.8–3.9), though none died during the period. Conclusions: Discharge against medical advice among post partum patients is uncommon, but occurs primarily among vulnerable women with psychosocial and medical risk factors. Thus, discharge against medical advice may help identify women who may benefit from additional maternal and/or child services.


Patient discharge Hospitalization Delivery obstetric Patient compliance 


  1. 1.
    Corley MC, Link K. Men patients who leave a general hospital against medical advice: Mortality rate within six months. J Stud Alcohol 1981;42:1058–1061.PubMedGoogle Scholar
  2. 2.
    Weingart SN, Davis RB, Phillips RS. Patients discharged against medical advice from a general medicine service. J Gen Intern Med 1998;13:568–571.PubMedCrossRefGoogle Scholar
  3. 3.
    Anis AH, Sun H, Guh DP, Palepu A, Schechter MT, O’Shaughnessy MV. Leaving hospital against medical advice among HIV-positive patients. CMAJ 2002;167:633–637.PubMedGoogle Scholar
  4. 4.
    Hwang SW, Li J, Gupta R, Chien V, Martin RE. What happens to patients who leave hospital against medical advice? CMAJ 2003;168:417–420.PubMedGoogle Scholar
  5. 5.
    Smith DB, Telles JL. Discharges against medical advice at regional acute care hospitals. Am J Public Health 1991;81:212–215.PubMedCrossRefGoogle Scholar
  6. 6.
    Dalrymple AJ, Fata M. Cross-validating factors associated with discharges against medical advice. Can J Psychiatr 1993;38:285–289.Google Scholar
  7. 7.
    Franks P, Meldrum S, Fiscella K. Discharges against medical advice: Are race/ethnicity predictors? J Gen Intern Med 2006;21(9):955–960.Google Scholar
  8. 8.
    Moy E, Bartman BA. Race and hospital discharge against medical advice. J Nat Med Assoc 1996;88:658–660.Google Scholar
  9. 9.
    Pages KP, Russo JE, Wingerson DK, Ries RK, Roy-Byrne PP, Cowley DS. Predictors and outcome of discharge against medical advice from the psychiatric units of a general hospital. Psychiatr Serv 1998;49:1187–1192.PubMedGoogle Scholar
  10. 10.
    Aliyu ZY. Discharge against medical advice: sociodemographic, clinical and financial perspectives. Int J Clin Pract 2002;56:325–327.PubMedGoogle Scholar
  11. 11.
    Chan AC, Palepu A, Guh DP, Sun H, Schechter MT, O’Shaughnessy MV et al. HIV-positive injection drug users who leave the hospital against medical advice: The mitigating role of methadone and social support. JAIDS 2004;35:56–59.PubMedGoogle Scholar
  12. 12.
    Jeremiah J, O’Sullivan P, Stein MD. Who leaves against medical advice? J Gen Intern Med 1995;10:403–405.PubMedCrossRefGoogle Scholar
  13. 13.
    Seaborn MH, Osmun WE. Discharges against medical advice: a community hospital's experience. Can J Rural Med 2004;9:148–153.Google Scholar
  14. 14.
    Saitz R, Ghali WA, Moskowitz MA. Characteristics of patients with pneumonia who are discharged from hospitals against medical advice. Am J Med 1999;107:507–509.PubMedCrossRefGoogle Scholar
  15. 15.
    Meux E. Encrypting personal identifiers. Health Serv Res 1994;29:247–256.PubMedGoogle Scholar
  16. 16.
    Zingmond DS, Ye Z, Ettner SL, Liu H. Linking hospital discharge and death records–accuracy and sources of bias. J Clin Epidemiol 2004;57:21–29.PubMedCrossRefGoogle Scholar
  17. 17.
    Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8–27.PubMedCrossRefGoogle Scholar
  18. 18.
    Saitz R, Ghali WA, Moskowitz MA. The impact of leaving against medical advice on hospital resource utilization. J Gen Intern Med 2000;15:103–107.PubMedCrossRefGoogle Scholar
  19. 19.
    AHRQ. Clinical Classification Software. available at http://www. accessed July 19, 2006).Google Scholar
  20. 20.
    Green P, Watts D, Poole S, Dhopesh V. Why patients sign out against medical advice (AMA): Factors motivating patients to sign out AMA. Am J Drug Alcohol Abuse 2004;30:489–493.PubMedCrossRefGoogle Scholar
  21. 21.
    Letterie GS, Markenson GR, Markenson MM. Discharge against medical advice in an obstetric unit. J Reprod Med 1993;38:370–374.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Departments of Family Medicine, and Community and Preventive MedicineUniversity of Rochester School of Medicine and DentistryRochesterUSA
  2. 2.Center for Health Services Research in Primary Care, Department of Family and Community MedicineUniversity of California School of Medicine, DavisSacramentoUSA

Personalised recommendations