Predicting which patients will be discharged against medical advice: a pilot study

Studies of patients signing out against medical advice (AMA) from a psychiatric service have been retrospective and inconsistent or contradictory in their findings. The authors report findings from a prospective study in which data from a brief structured interview of patients at the time of admission were used to predict subsequent AMA behavior. They achieved 80% accuracy. Critical variables centered around the nature of the "treatment contract" as perceived by the patient: AMA patients never intended to stay in the hospital for more than a few days.