ORIGINAL RESEARCH article
Front. Health Serv.
Sec. Patient Centered Health Systems
Volume 5 - 2025 | doi: 10.3389/frhs.2025.1620715
This article is part of the Research TopicChallenges, Opportunities & Outcomes of Patient-Oriented Research in Learning Health SystemsView all 8 articles
The Experiences of Patients who Leave Hospital Against Medical Advice: Analysis of Survey Data
Provisionally accepted
- University of Calgary, Calgary, Canada
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Background: Historically, when patients leave hospital against medical advice (LAMA), the focus has often been on non-compliance or patient-level factors, rather than on how services may be designed to better support these patients. Efforts to better understand why patients LAMA could strengthen the provision of patient-centered care that is responsive to individual needs and values. This study aimed to explore the experiences of Albertan adults who LAMA by examining patient-centered quality indicators (PC-QIs) derived from survey data. We sought to identify actionable insights that may inform service improvements and reduce the risks associated with LAMA discharges. Methods: We analyzed seven years of survey data, encompassing hospital discharges from April 2016 to March 2023. A random sample of respondents completed the Canadian Patient Experiences – Inpatient Care (CPES-IC) instrument by telephone within six weeks of hospital discharge. From the data, we assessed ten patient-centred quality indicators (PC-QI) which were previously co-created with patient advisors, researchers, and health system administrators. Survey responses/PC-QIs were reported as percent in “top box”, as represented by the most positive answer choice. Differences between patients who LAMA and other medical/surgical discharges were assessed. Results: A total of 144,480 surveys were successfully linked with inpatient records and included for analysis. This included 1,177 (0.9%) respondents who LAMA. In our sample, those who LAMA were predominantly male, younger, had a lower level of educational attainment, and were living with a greater number of comorbid health conditions. They also had lower self-reported levels of physical and mental health and had a longer average length of stay. The LAMA group had significantly lower top-box percentages on all ten of the PC-QIs which we examined. This difference ranged from 20.7% (communicating test results; 51.6% LAMA group vs. 71.3% others) to 29.2% (patient involvement in decisions about their care and treatment; 39.8% vs. 69.0% respectively). Conclusion: Patients who LAMA reported lower ratings of patient experience across all PC-QIs studied. Our findings may provide actionable, service-related insights into reasons why patients LAMA. This is important as those who do so may place themselves at increased risk for future unplanned healthcare events, mortality, and morbidity.
Keywords: Survey, patient experience, Leaving against medical advice (LAMA), Hospital, patient centered care
Received: 30 Apr 2025; Accepted: 09 Sep 2025.
Copyright: © 2025 Kemp, Steele, Fairie and Santana. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Kyle Kemp, University of Calgary, Calgary, Canada
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