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标题：Frequency and trends of hospital discharges against medical advice (DAMA) in a large administrative database
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作者：Mario Saia ; Alessandra Buja ; Domenico Mantoan 等
期刊名称：Annali dell'Istituto Superiore di Sanita
印刷版ISSN：0021-2571
出版年度：2014
卷号：50
期号：4
页码：357-362
DOI：10.4415/ANN_14_04_11
出版社：Editrice Kurtis Srl
摘要：Objective. The aim of this research was to characterize hospitalizations associated with discharges against medical advice (DAMA) in a large, population-based data system. Materials and methods. This was a retrospective cohort study on 11 436 500 hospital admissions. The hospital discharge records for residents of the Veneto region (north-east Italy) discharged from 2001 to 2012, from both public and accredited private hospitals, were considered. The DAMA rate was calculated by type of hospital admission, exclud- ing patients who died. The time trend of the DAMA rate was charted from the average annual percent changes. Results. During the period considered, 66 549 DAMA were recorded, amounting to an overall DAMA rate of 6.0‰ admissions. Analyzing the diagnostic categories, admis- sions for substance abuse (drugs or alcohol) and dependence coincided with the highest DAMA rate (83.5‰), followed by poisoning (40.2‰), psychiatric disorders (24.7 ‰), traumas (21.1‰), HIV-related diseases (19.9‰), burns (10.5‰), and – for women – is- sues relating to pregnancy, childbirth and the postnatal period (11.2‰). The DAMA rate dropped from 6.72 to 5.55 from 2000 to 2008, then remained stable. Conclusion. The DAMA rate dropped slightly over the period considered. Several di- agnostic categories are associated with a higher likelihood of patients leaving hospital against their doctor's advice.
关键词：delivery of health care ; . health care surveys ; . hospital administration