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Patients Leaving California Hospitals Against Medical Advice (AMA)

In 2019-2020, there were 133,445 discharges against medical advice in California, representing 2.6 percent of all discharges.

Patients leaving California hospitals against medical advice (AMA) is defined as choosing to leave the hospital before the treating physician recommends discharge. Patients leaving AMA 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 23 percent of AMA discharges, but only 5 percent of total discharges in 2019-2020. In discharges amongst patients who left AMA more than once, this trend is even more pronounced.

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), and diabetes.
  • Sepsis is the most common primary diagnosis among all discharges and remains 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 2019-2020 represent 0.8 percent of all discharges.
  • Patients who leave the hospital AMA tend to show much higher readmission rates than patients discharged by a healthcare provider.

In the first visualization, 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 more than once in 2019-2020 represent 0.8 percent of all discharges.
  • Patients who leave the hospital AMA tend to show much higher readmission rates than patients discharged by a healthcare provider.

The visualization below compares readmission rates of patients readmitted after leaving AMA versus those who did not previously leave AMA. The readmission rates are broken down by the number of days between the previous discharge and the subsequent readmission.

Patients who leave the hospital AMA tend to show higher readmission rates than patients who were discharged by a healthcare provider. Readmission rates are highest for patients discharged AMA and are then readmitted only one day later. After this peak, readmission rates continue to trend downward.

Note: The ten primary diagnoses used in the visualizations represent the most common diagnoses present across all discharges as well as AMA discharges in 2019-2020. The primary diagnosis uses International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and code groupings to determine categorization. The ICD-10-CM is a system used by healthcare providers to classify and code all diagnoses, symptoms, and procedures recorded in conjunction with hospital care.

View Underlying Data

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

Additional Information

Topic: Healthcare Utilization
Source Link: Department of Health Care Access and Information: Patient Discharge Data
Citation: HCAI – Patient Discharge Data – Patients Leaving California Hospitals Against Medical Advice (AMA), 2019-2020
Temporal Coverage: 2019-2020
Spatial/Geographic Coverage: Statewide
Frequency: Annually