Structural Racism in the Hospital: Against Medical Advice Discharge
Saturday, October 14, 2023
9:00 AM – 10:15 AM ET
Location: Bristol (Third Floor)
Approximately 1-2% of all hospitalizations in the US result in an against medical advice (AMA) discharge. In the largest national study of AMA discharge, Black or African American patients are more likely than patients of other races to be discharged AMA, even after controlling for other variables including underlying medical conditions and socioeconomic status. This disparity is especially concerning in conjunction with the literature describing the adverse health outcomes after an AMA discharge, including readmission and increased morbidity and mortality. This presentation uses existing AMA and racial disparities research to map out the standard hospital course, from admission to departure, of patients who are ultimately discharged AMA. Examining this map, we identify vulnerability points at which implicit bias and structural racism result in higher rates of AMA discharge for Black patients. We will examine the admission, including the admission documentation; aspects of the hospital course such as pain and symptom control and clinician communication; and the different decisions that are made once the patient requests early discharge, such as the assessment of capacity. Identifying and modifying institutional behaviors and norms that perpetuate structural racism is necessary to rebuild a more just and safe health care system for patients.
Ryan Harris, MD – Psychiatry and Mental Health Service – R. L. Roudebush VA Medical Center