{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T06:10:08Z","timestamp":1758867008539,"version":"3.44.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Historically, when patients leave hospital against medical advice (LAMA), the focus has often been on non-compliance or other 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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 \u2013 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 \u201ctop box\u201d, as represented by the most positive answer choice. Differences between patients who LAMA and other medical\/surgical discharges were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients who LAMA reported lower ratings of patient experience across all PC-QIs studied. Our findings may provide actionable, service-related insights into the 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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/frhs.2025.1620715","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T05:31:50Z","timestamp":1758864710000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The experiences of patients who leave hospital against medical advice: analysis of survey data"],"prefix":"10.3389","volume":"5","author":[{"given":"Kyle","family":"Kemp","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Steele","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Fairie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria 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