Document Type : Original Article
Authors
1 Assistant Professor, Health Services Management, Shiraz University of Medical Sciences, Shiraz, Iran
2 Associate Professor, Health Services Management, Shiraz University of Medical Sciences, Shiraz, Iran
3 Health Services Management, Shiraz University of Medical Sciences, Shiraz, Iran
4 Health Economics, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Introduction: Patient/customer satisfaction and loyalty have gained increasing attention from
executives across the healthcare industry. Discharge against medical advice (DAMA) can be
considered as one of the indicators of patient dissatisfaction. It has negative effects on patient
treatment and leads to increased hospital costs. Study of predictors of DAMA in a teaching
hospital was the aim of this research.
Methods: In this retrospective, case-control study during the winter if 2009, a total of 9463
discharged patient medical records were reviewed. They were selected based on kind of discharge
using systematic sampling. Data was analyzed using chi-square test and t-test and binary
regression in SPSS.
Results: Overall, 9% of discharges in this period were against medical advices. There were
significant associations between DAMA and health insurance status, hospital wards, and kind of
disease. Emergency ward patients and patients with no health insurance were more likely to DAMA.
Conclusion: High rate of DAMA should be considered by hospital managers. They should try to
find out the causes of DAMA to prevent it and finally improve satisfaction and loyalty of patients.
Keywords
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