Impact of Discharging Patients Against Medical Advice on Outcomes and Healthcare Costs

Discharging patients against medical advice (DAMA) affects not only individual health outcomes but also contributes significantly to healthcare system costs. Approximately 1% to 2% of all inpatient hospital stays result in DAMA, which is associated with over $800 million in annual expenses. Recent research analyzed patterns, risk factors, and consequences of DAMA, shedding light on the pressing need for targeted interventions.

The study, conducted by researchers from Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, utilized data from the Nationwide Readmissions Database (2016–2020). They examined adult patients undergoing major surgeries across various specialties, including emergency and psychiatric services. Findings indicated that DAMA rates increased from 17% in 2016 to 25.3% in 2020, with factors like male gender, younger age, and substance use disorder being strongly associated.

Patients who leave prematurely tend to be in worse clinical states, face higher risks of complications, and have increased likelihood of readmission within 30 days. Longer hospital stays and higher treatment costs are also linked with DAMA patients. The study highlights the critical need to develop risk stratification methods and improve discharge planning to prevent unnecessary readmissions and optimize healthcare resource utilization.

As the incidence of DAMA rises, so does its financial burden, prompting healthcare providers to explore strategies that address underlying socioeconomic, care dissatisfaction, and symptom management issues. For more detailed insights, see the original publication in the Journal of the American College of Surgeons.