Care at Burn Centers Is Associated With Reduced Discharge Against Medical Advice: A National, Multi-Database Analysis.

Discharge against medical advice (AMA) leads to worse outcomes in patients with burn injuries, including higher readmission rates, wound complications, and elevated costs, although protective and risk factors remain incompletely characterized. Burn encounters were identified in 2 national databases, the Nationwide Inpatient Sample (NIS), 2016-2021, and the Burn Care Quality Platform (BCQP), 2016-2022. Encounters were stratified by AMA discharge. The primary outcomes were the overall incidence of AMA discharge and the effects of inpatient psychosocial or behavioral interventions and burn center status on AMA discharge, evaluated with 1:1 nearest-neighbor propensity-score matching of AMA and non-AMA encounters on demographics, burn characteristics, and established risk factors for AMA discharge, without replacement and with a maximum caliper distance of 0.1. In the NIS and BCQP, 5950 (2.8%) of 214 390 and 2923 (1.4%) of 205 993 burn encounters, respectively, were discharged AMA. Significant predictors of AMA discharge included male sex, Medicaid or self-pay insurance status, smaller burn size, and a more recent admission year (P < .01). The incidence of AMA discharge increased over the study period in both the NIS (incidence rate ratio [IRR] 1.2; 95% CI, 1.1-1.2; P < .01) and the BCQP (IRR 1.2; 95% CI, 1.2-1.2; P < .01). Within a propensity-score matched model, burn center care was associated with a 1.2% decrease in AMA discharge (average treatment effect, -0.01; 95% CI, -0.02 to -0.00; P = .01); psychosocial or behavioral interventions did not impact the likelihood of AMA discharge (P = .85). Existing interventions to mitigate AMA discharge are insufficient to significantly alter these patterns. Treatment at a burn center may result in a lower likelihood of AMA discharge in patients with burn injuries.