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Objective: To examine risk factors and sequela for post partum discharge against medical advice., Methods: We conducted cross-sectional analyses of hospital discharge data linked to American Hospital Association data for women discharged following a live birth for California, Florida, and New York in the years 1998-2000. We examined rates, risk factors, hospital readmission rate and mortality (California only), associated with discharge against medical advice after controlling for patient and hospital characteristics., Results: Post partum discharge against medical advice averaged 0.10%. Rates were lowest among women following uncomplicated cesarean and vaginal births (0.07%), intermediate following complicated vaginal birth (0.21%) and highest following complicated cesarean birth (0.29%). African American race, lower income, public health insurance, no health insurance, or greater comorbidity, particularly drug abuse or psychotic illness, discharge from a hospital in California or New York (compared to Florida), and location in medium or large metropolitan areas, were associated with significantly higher rates of discharge against advice. Asian or Hispanic race or ethnicity and delivery at an obstetrical specialized hospital were associated with lower risk. Patients discharged against medical advice in California were significantly more likely to be re-admitted within 30 days (adjusted odds ratio 2.7; 95% confidence interval [CI] 1.8-3.9), though none died during the period., Conclusions: Discharge against medical advice among post partum patients is uncommon, but occurs primarily among vulnerable women with psychosocial and medical risk factors. Thus, discharge against medical advice may help identify women who may benefit from additional maternal and/or child services.

Background: Prior literature suggests that blacks are more likely to be discharged against medical advice (DAMA)., Objective: We examined whether DAMA from general hospitals varies by race/ethnicity and whether this variation is explained by individual and hospital factors. DESIGN, SUBJECTS, AND MEASUREMENTS: We conducted cross-sectional analyses of 1998 to 2000 hospital discharge data, linked to the American Hospital Association data, on adults admitted for acute general hospital care in California, Florida, and New York. A series of hierarchical logistic regression analyses explored factors associated with DAMA, initially adjusting for age and gender, then sequentially adding adjustment for comorbidities, individual socio-economic factors, and finally hospital characteristics., Results: Compared with whites, blacks had a 2-fold higher age-gender adjusted odds of DAMA, a risk that progressively diminished with increasing adjustment (final adjusted odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.91, 1.00). While Hispanics had an increased risk of DAMA in age-gender-adjusted analyses, the final model revealed a protective effect (adjusted OR = 0.66, 95% CI = 0.62, 0.70), similar to that observed for Asians., Conclusions: Disparities in DAMA affecting minority patients in general hospitals are largely accounted for by individual and hospital socio-economic factors. The absence of any adjusted disparity affecting blacks, and the protective effect observed for Hispanics and other minorities suggest that individual discrimination and poor communication are not primary determinants of DAMA, but where patients are admitted does contribute to disparities in DAMA.