Kim Hwan, Colantonio Angela
Department of Occupational Therapy, College of Rehabilitation Sciences, Daegu University, Republic of Korea.
Brain Inj. 2013;27(3):325-31. doi: 10.3109/02699052.2012.750741.
Discharges against medical advice (DAMA) have been considered predictors of adverse outcomes for patients in acute care and psychiatric hospitals. However, little is known about the profile of patients who discharge AMA admitted to rehabilitation hospitals. The aims of this study were to provide a profile of patients who received inpatient rehabilitation services following a traumatic brain injury (TBI) who discharged AMA and to compare this group with the regular discharge group.
Retrospective cohort study.
Hospital discharge data from two national administrative databases were reviewed for the years 2001-2006.
The databases yielded 1559 cases of TBI (average length of stay = 51 days). Of these, 31 (2.0%) had recorded DAMA events: one in 50 patients left rehabilitation against medical advice. Compared to regular discharge (n = 1247), DAMA was significantly associated with unemployment, intentional injury, higher motor functions at admission and shorter length of stay. Known factors for DAMA in acute hospitals, such as male sex, young age and substance abuse history, were not significant.
Careful screening and assessment of patients who discharge AMA could enable better prevention and management strategies, thus improving health outcomes and enhancing healthcare delivery.
在急症医院和精神病医院，违反医嘱出院（DAMA）被视为患者不良结局的预测因素。然而，对于康复医院中违反医嘱出院患者的情况却知之甚少。本研究的目的是描述创伤性脑损伤（TBI）后接受住院康复服务且违反医嘱出院的患者情况，并将该组患者与正常出院组进行比较。
回顾性队列研究。
对2001年至2006年两个国家行政数据库中的医院出院数据进行回顾。
数据库中有1559例TBI病例（平均住院时间=51天）。其中，31例（2.0%）有违反医嘱出院记录：每50名患者中有1人违反医嘱离开康复医院。与正常出院患者（n=1247）相比，违反医嘱出院与失业、故意伤害、入院时较高的运动功能以及较短的住院时间显著相关。急性医院中已知的违反医嘱出院因素，如男性、年轻和药物滥用史，并不显著。
对违反医嘱出院的患者进行仔细筛查和评估，可制定更好的预防和管理策略，从而改善健康结局并提高医疗服务质量。
