Insurance-related Risk Factors for Leaving Against Medical Advice after Opioid Overdose: A Cross-sectional Study Using Electronic Health Records.

Objectives: The United States is in an overdose crisis, with many Americans seeking emergency medical services for drug overdose. Patients who leave against medical advice (AMA) have higher risk of subsequent health complications and hospital readmission. This cross-sectional study uses electronic health records (EHRs) to identify insurance-related risk factors for leaving AMA among patients hospitalized for opioid overdose.

Methods: Documented opioid overdose hospitalizations between June 2019 and November 2021 were identified using ICD-10 codes from EHR at a large Midwest academic hospital. Multivariate logistic regression was used to identify risk factors associated with leaving AMA. Opioid overdose hospitalizations were aggregated by patient, and bivariate analyses (χ2​​​​​, ANOVA) and logistic regression were used to test for associations between demographics and repeat hospitalization.

Results: Among 3608 hospitalizations, 2985 unique patients were admitted. Compared with Medicare, patients with all other specified insurance types were more likely to leave AMA: self-pay 294% more (aOR = 3.94; 95% CI = 1.83-10.34), Medicaid 299% more (aOR = 3.99; 95% CI = 1.78-10.72), and commercial 402% more (aOR = 5.02; 95% CI = 1.88-14.94). Risk factors for repeat hospitalization included black race (aOR = 1.61, 95% CI = 1.26,2.07), and young age (aOR = 0.99, 95% CI = 0.98, 0.99), while female sex was associated with decreased odds (aOR = 0.73, 95% CI = 0.57, 0.92).

Conclusions: Insurance may be associated with AMA discharge after opioid overdose. Tailored interventions addressing patients' financial concerns after hospitalization may increase access to care and reduce inequities.