DISCHARGES AGAINST MEDICAL ADVICE: ASSOCIATIONS WITH SELECTED OUTCOMES AND THE ROLE OF HOSPITAL-LEVEL CHARACTERISTICS

DAMA;Against Medical Advice;left AMA;Discharged AMA;Healthcare Leadership & Management

Byun, HoonStuart, Elizabeth A. ;

Johns Hopkins University

关键词: DAMA;    Against Medical Advice;    left AMA;    Discharged AMA;    Healthcare Leadership & Management;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/40723/BYUN-DISSERTATION-2016.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Discharges Against Medical Advice or ;;DAMA’ occur when patients decide to withdraw consent and leave care against the advice of the treating physician. Studies have found this phenomenon to account for 1-2% of all US hospital discharges. It is a problematic subject, where the rights of the patient can and do clash with the responsibilities of the physician, which can result not only in conflict, but also worse health outcomes, wasted resources, and legal liability. By using both anonymized and publicly available administrative healthcare data, this study investigated the factors associated with DAMA in two different sets of data by matching DAMA observations with similar non-DAMA observations and comparing outcomes. Finally, the study investigated the existence of characteristics at the hospital levelthat are associated with high levels of DAMA. The study found associations between discharges against medical advice and selected outcomes, such as a higher likelihood of 30-day readmission, longer lengths of stay, higher costs, and increased severity of illness on the readmission visit in comparison to the index visit at one prominent hospital. Also, the study found associations between discharges against medical advice and decreased lengths of stay, total costs, and lower severity of illness on the index visit at both the study hospital, as well as nationally. Finally, the study found evidence that there are patient level and hospital level characteristics that are associated with higher than expected levels of discharges against medical advice, and that certain hospitals are at increased risk for experiencing DAMA.This study confirms the notion that DAMA is an issue worth addressing in order to improve the conditions of the patient, provider, and hospital.