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Summary of Statistical Brief
SUMMARY OF STATISTICAL BRIEF Author 2
Summary of Statistical Brief
The statistical brief selected for review presents data determined by the Healthcare Cost and Utilization Project (HCUP) regarding the incidence of patients leaving the hospital against medical advice (AMA) According to Stranges, Wier, Merrill and Steiner (2009), this circumstance is extremely important because “patients who leave the hospital against medical advice maybe at increased risk for adverse health outcomes. Also, patients who leave AMA have significantly higher readmission rates compared to other patients.” The authors go on to list the reasons a patient may leave AMA such as economics, financial concerns or not being pleased with their medical treatment. A signed AMA form, however, does not preclude the hospital or physicians from medical liability (Fleeter, 2012). Unfortunately, this is a complex issue facing the medical community, with not much documentation on the subject (Fleeter, 2012).
The data analyzed was presented in three tables and four graphs. The first table characterized hospital stays by patients that left AMA and all other hospital stays. The second table examined individual characteristics of patients that left AMA versus other patients. Some of the characteristics included were age, gender, hospital region and income level. The third table described the top five principal diagnoses of patients that left AMA. These included non-specific chest pain, alcohol related disorders, mood disorders, diabetes with complications and substance related disorders. The graph in Figure 1 illustrates the incidence of patients leaving AMA increased by 30 percent versus other hospital stays from 1997 to 2007, while Figure 2 shows the incidence of patients leaving AMA was twice as high in the Northeast as in other area for 2007. Lastly, Figure 3 depicted that the rate of patients leaving AMA that were uninsured or on Medicaid accounted for half of the discharges versus the 20 percent rate of all other hospital
stays. The major discoveries of the research were “the number of hospital stays in which patients left AMA grew by 39 percent between 1997 and 2007 to 368,000 stays. The growth in these stays exceeded that of all other stays combined during this period (13 percent)” (Stranges et al., 2009). In addition, “Uninsured and Medicaid stays accounted for nearly half of all AMA stays, but less than 20 percent of all other stays” (Stranges et al., 2009).
The purpose of this statistical survey was to denote and examine why patients left AMA from hospital stays to determine a course of action so hospitals and physicians could implement the necessary measures to protect themselves from medical liability. This is a result of much higher readmission rates for patients that leave AMA and the “adverse health outcomes” that follow (Stranges et al., 2009). After reviewing an article by Fleeter, it becomes apparent that a patient simply signing a release form acknowledging they are leaving the facility AMA is not enough to ward off medical liability for the institution or its employees. Fleeter uses the example of a patient that arrives at the emergency room with a severely fractured arm. The young male is intoxicated, irritable and very impatient. When it takes the physician several hours to treat him, he demands to be released. Although he signs a medical release stating he chose to leave AMA, will the physician still be liable if a deformity or other situation develops because the injury was not properly treated? (Fleeter, 2012).
Fleeter (2012) then goes on to discuss through his research the incidence of patients leaving AMA, which he finds is under 2.0 of all hospital stays and characterizes them primarily as young, male and with additional psychological or substance abuse problems. After reviewing relevant case law, he determined that on many occasions doctors have not been found liable, however, these types of patients are more likely to sue (Fleeter, 2012). After reviewing the
statistical data and Fleeter’s work, it becomes apparent this is an issue medical practitioners and hospitals must examine in order to protect themselves from possible significant legal action. With liability insurance being as expensive as it is this in profession, it is only warranted research such as this should be undertaken. It is merely to protect health care providers when they are not allowed to complete their treatment.
Fleeter, Thomas B. (2012). When a Patient Leaves Against Medical Advice. American Academy
Of Orthopaedic Surgeons. Retrieved from
Stranges, E., Wier, L., Merrill, C., & Steiner, C. (August 2009). Hospitalizations in which
Patients Leave the Hospital Against Medical Advice (AMA). Retrieved from
Elizabeth Stranges, MS, Lauren Wier, MPH, Chaya T. Merrill, DrPH, and Claudia Steiner, MD, MPH