Discharges Against Medical Advice: Prevalence, Predictors, and Populations

  • Madhuram Nagarajan
  • Ada Ibe Offurum
  • Mangla Gulati
  • Eberechukwu Onukwugha


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.


Discharge against medical advice Against medical advice Leave against medical advice DAMA AMA LAMA 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Madhuram Nagarajan
    • 1
  • Ada Ibe Offurum
    • 2
    • 3
  • Mangla Gulati
    • 2
    • 3
  • Eberechukwu Onukwugha
    • 1
  1. 1.Department of Pharmaceutical Health Services ResearchUniversity of Maryland School of PharmacyBaltimoreUSA
  2. 2.Department of MedicineUniversity of Maryland School of MedicineBaltimoreUSA
  3. 3.University of Maryland Medical CenterBaltimoreUSA

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