Factors Affecting Discharge against Medical Advice in a Teaching Hospital in Shiraz, Iran*

Document Type : Original Article

Authors
Zahra Kavosi 1
Nahid Hatam 2
Hadi Hayati Abbarik 3
Javid Nemati 3
Mohsen Bayati 4
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

1. Asefzade S, Reza Pour A. Planning and management of health. Tehran: Tehran University Publication; 1990.
[In Persian].
2. Hwang SW, Li J, Gupta R, Chien V, Martin RE. What happens to patients who leave hospital against medical
advice? CMAJ 2003; 168(4): 417-20.
3. Jeremiah J, O'Sullivan P, Stein MD. Who leaves against medical advice? J Gen Intern Med 1995; 10(7): 403-5.
4. AIHW. Aboriginal and Torres Strait Islander Health Performance Framework 2008 report: detailed analyses
[Online]. 2009 [cited 2009 Jan 19]; Available from: URL: http://www.aihw.gov.au/publicationdetail/?
id=6442468199/
5. Barclay L, Fletcher M, Guthridge S, Henry B, Heslop J, Patel B, et al. Self-discharge against medical advice from
Northern Territory Hospitals Prevalence rates, experiences and suggestions, economic implications and
recommended strategies for improvement [Online]. 2007; Available from: URL:
http://www.cdu.edu.au/ehs/health/nursing/documents/SelfDischargereport.pdf/
6. Franks P, Meldrum S, Fiscella K. Discharges against medical advice: are race/ethnicity predictors? J Gen Intern
Med 2006; 21(9): 955-60.
7. Pennycook AG, McNaughton G, Hogg F. Irregular discharge against medical advice from the accident and
emergency department--a cause for concern. Arch Emerg Med 1992; 9(2): 230-8.
8. Tavallaei SA, Asari SH, Habibi M, Khodami HR, Siavoshi Y, Nouhi S, et al. Discharge Against Medical Active
from Psychiatric Ward. J Mil Med 2006; 8(1): 24-30. [In Persian].
9. Asefzade S. Principles of Health care Economics. 2nd ed. Qazvin: Qazvin University of Medical Sciences
Publication; 2007. [In Persian].
10. Rangraz Jeddi F, Rangraz jeddi M, Rezaeiimofrad M. Patients' Reasons for Discharge against Medical Advice in
University Hospitals of Kashan University of Medical Sciences in 2008. Hakim 2010; 13(1): 33-9. [In Persian].
11. Ibrahim SA, Kwoh CK, Krishnan E. Factors associated with patients who leave acute-care hospitals against
medical advice. Am J Public Health 2007; 97(12): 2204-8.
12. Alfandre DJ. "I'm going home": discharges against medical advice. Mayo Clin Proc 2009; 84(3): 255-60.
13. Anis AH, Sun H, Guh DP, Palepu A, Schechter MT, O'Shaughnessy MV. Leaving hospital against medical
advice among HIV-positive patients. CMAJ 2002; 167(6): 633-7.
14.Weingart SN, Davis RB, Phillips RS. Patients discharged against medical advice from a general medicine service.
J Gen Intern Med 1998; 13(8): 568-71.
15. Smith HH, Jr. Discharge against medical advice (AMA) from an acute care private psychiatric hospital. J Clin
Psychol 1982; 38(3): 550-4.
Health Information Management
Volume 9, Issue 4
September and October 2012
Pages 448-456