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Discharges Against Medical Advice: Prevalence, Predictors, and Populations

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Against‐Medical‐Advice Discharges from the Hospital

Abstract

Discharge against medical advice (DAMA) is when a patient leaves a healthcare institution, typically a hospital where the patient is admitted, before it is deemed medically appropriate. DAMA constitutes approximately 1% of all US hospital discharges; however, the proportion of those leaving against medical advice may be higher in certain populations, and not all DAMA will be avoidable.

We summarize the existing literature and offer a framework to view what is known about DAMA, with the discussion primarily centered on “high-risk” patients and provider liability. While DAMA may seem to be an issue of patient autonomy, the decision-making occurs within a broader interpersonal, community, and social context that is captured using non-patient-level factors.

We argue for investigation of and characterization of the effect of non-patient-level factors that contribute to DAMA, in addition to the better-understood patient-level factors. Building on a richer framework that considers patient and non-patient-level factors, we propose that future research should identify effective multilevel interventions to reduce avoidable DAMA.

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Authors and Affiliations

  1. Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, 21201, USA

    Madhuram Nagarajan & Eberechukwu Onukwugha

  2. Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA

    Ada Ibe Offurum & Mangla Gulati

  3. University of Maryland Medical Center, Baltimore, MD, 21201, USA

    Ada Ibe Offurum & Mangla Gulati

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  1. Madhuram Nagarajan
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  2. Ada Ibe Offurum
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  3. Mangla Gulati
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  4. Eberechukwu Onukwugha
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Correspondence to Eberechukwu Onukwugha .

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Editors and Affiliations

  1. VHA National Center for Ethics in Health Care, Department of Veterans Affairs, NYU School of Medicine, New York, New York, USA

    David Alfandre

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Nagarajan, M., Offurum, A.I., Gulati, M., Onukwugha, E. (2018). Discharges Against Medical Advice: Prevalence, Predictors, and Populations. In: Alfandre, D. (eds) Against‐Medical‐Advice Discharges from the Hospital. Springer, Cham. https://doi.org/10.1007/978-3-319-75130-6_2

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  • DOI: https://doi.org/10.1007/978-3-319-75130-6_2

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