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Patient-Physician Sex Discordance and “Before Medically Advised” Discharge from Hospital: A Population-Based Retrospective Cohort Study

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Abstract

Background

Patient-physician sex discordance (when patient sex does not match physician sex) has been associated with reduced clinical rapport and adverse outcomes including post-operative mortality and unplanned hospital readmission. It remains unknown whether patient-physician sex discordance is associated with “before medically advised” hospital discharge (BMA discharge; commonly known as discharge “against medical advice”).

Objective

To evaluate whether patient-physician sex discordance is associated with BMA discharge.

Design

Retrospective cohort study using 15 years (2002–2017) of linked population-based administrative health data for all non-elective, non-obstetrical acute care hospitalizations from British Columbia, Canada.

Participants

All individuals with eligible hospitalizations during study interval.

Main Measures

Exposure: patient-physician sex discordance. Outcomes: BMA discharge (primary), 30-day hospital readmission or death (secondary).

Results

We identified 1,926,118 eligible index hospitalizations, 2.6% of which ended in BMA discharge. Among male patients, sex discordance was associated with BMA discharge (crude rate, 4.0% vs 2.9%; adjusted odds ratio [aOR] 1.08; 95%CI 1.03–1.14; p = 0.003). Among female patients, sex discordance was not associated with BMA discharge (crude rate, 2.0% vs 2.3%; aOR 1.02; 95%CI 0.96–1.08; p = 0.557). Compared to patient-physician sex discordance, younger patient age, prior substance use, and prior BMA discharge all had stronger associations with BMA discharge.

Conclusions

Patient-physician sex discordance was associated with a small increase in BMA discharge among male patients. This finding may reflect communication gaps, differences in the care provided by male and female physicians, discriminatory attitudes among male patients, or residual confounding. Improved communication and better treatment of pain and opioid withdrawal may reduce BMA discharge.

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Data Availability

Access to data provided by the Data Stewards is subject to approval, but can be requested for research projects through the Data Stewards or their designated service providers. All inferences, opinions, and conclusions drawn are those of the authors and do not reflect the opinions or policies of the Data Stewards.

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Funding

This study was supported by the Canadian Institutes of Health Research (grant numbers PJT-180343 & PJT-183955), the Vancouver Coastal Health Research Institute Innovation and Translational Research Award (AWD-017961), and the UBC Division of General Internal Medicine. JAS was supported by a Health Professional-Investigator Award from Michael Smith Health Research BC. Funding organizations were not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation and review of this abstract.

Author information

Authors and Affiliations

  1. Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    Mayesha Khan MA, Ying Yu PhD, Daniel Daly-Grafstein MSc, Hiten Naik MD FRCPC, Karen C. Tran MD, MHSc, FRCPC, Trudy Nasmith MDCM, MSc, FRCPC & John A. Staples MD, MPH, FRCPC, FACP

  2. Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada

    Mayesha Khan MA, Ying Yu PhD, Daniel Daly-Grafstein MSc & John A. Staples MD, MPH, FRCPC, FACP

  3. Department of Statistics and Actuarial Science, Simon Fraser University, Vancouver, BC, Canada

    Ying Yu PhD

  4. Department of Statistics, University of British Columbia, Vancouver, BC, Canada

    Daniel Daly-Grafstein MSc

  5. Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada

    Jason M. Sutherland PhD

  6. Centre for Health Evaluation and Outcome Sciences (CHÉOS), Vancouver, BC, Canada

    Karen C. Tran MD, MHSc, FRCPC

  7. Division of Hospital Medicine, Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA

    Jennifer R. Lyden MD

  8. Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA

    Jennifer R. Lyden MD

  9. Vancouver General Hospital Research Pavilion, 828 West 10th Avenue, Vancouver, BC, Canada

    John A. Staples MD, MPH, FRCPC, FACP

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  1. Mayesha Khan MA
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Contributions

JAS and MK were responsible for study concept. All authors contributed to the study design. JAS and MK designed the analytic strategy. JAS was responsible for acquisition of the data. MK had full access to all study data and was responsible for the integrity of the data and the accuracy of the data analysis. YY and DD contributed to the data analysis. JAS and MK were responsible for drafting the manuscript. All authors were responsible for critical revisions of the manuscript.

Corresponding author

Correspondence to John A. Staples MD, MPH, FRCPC, FACP.

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Khan, M., Yu, Y., Daly-Grafstein, D. et al. Patient-Physician Sex Discordance and “Before Medically Advised” Discharge from Hospital: A Population-Based Retrospective Cohort Study. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08697-8

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  • DOI: https://doi.org/10.1007/s11606-024-08697-8

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