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Patients who leave the hospital against medical advice (AMA) tend to be younger, healthier, and more likely to have substance abuse and psychiatric comorbidities than patients with planned discharges. But do they have worse outcomes? To find out, investigators retrospectively evaluated 30-day mortality and readmission rates in 3500 AMA general medical discharges and 80,000 planned discharges to home without services from an urban medical center in New York. In matched analyses, they compared the AMA discharges with 3500 propensity score–matched planned discharges. Analyses were controlled for factors likely to affect AMA rates (e.g., age, sex, substance abuse, psychiatric illness) and other comorbidities.
Thirty-day mortality was double in t…