Ashrafi Ensieh, Nobakht Samin, Keykaleh Meysam Safi, Kakemam Edris, Hasanpoor Edris, Sokhanvar Mobin
M.Sc. in Health Services Management, Shahid Labbafinejad Hospital, Social Security Organization (SSO), Tehran, Iran.
M.Sc. in Health Services Management, Department of Health Management, Tehran Science and Research Branch, Islamic Azad University, Tehran, Iran.
Electron Physician. 2017 Jun 25;9(6):4563-4570. doi: 10.19082/4563. eCollection 2017 Jun.
DAMA is a result of patient dissatisfaction, which increases the rate of readmission, mortality, and complications. In this study, the causes and predictors of DAMA in Shahid Labbafinejad Hospital of Tehran were determined.
The descriptive and analytical study was conducted in 2016 from the information of 1,168 hospitalized patients in the period of 2015 and the first half of 2016. Patients' information was collected using checklists and through clinical records, nursing unit reports, and telephone calls. The collected data were analyzed using SPSS-v18 software and by employing chi-square test and logistic regression modeling.
The DAMA rate was estimated at 3.27%. Among the causes of DAMA, the high rates were related to personal problems (39.04%) and going to other centers (34.93%), and the lowest level was related to dissatisfaction with the physician (3.08%). Age groups (19-37, OR=2.17), (38-56 years, OR=1.70), and (57-75, OR=1.62), gender (male, OR=1.47), locations (Tehran city, OR=0.61) and (Tehran Province, OR=0.63) were predictors of DAMA (p<0.05).
The importance of DAMA requires practical measures such as creating a suitable environment for patients, providing consulting services for youth, improving staff relations, providing assistance for patients in need, and removing accommodation problems of patients and their companions to reduce the DAMA.
未经医嘱擅自离院（DAMA）是患者不满的结果，这会增加再入院率、死亡率和并发症发生率。本研究旨在确定德黑兰沙希德·拉巴菲内贾德医院DAMA的原因及预测因素。
本描述性和分析性研究于2016年进行，数据来源于2015年及2016年上半年1168例住院患者的信息。通过检查表以及临床记录、护理单元报告和电话收集患者信息。使用SPSS - v18软件并采用卡方检验和逻辑回归模型对收集的数据进行分析。
DAMA率估计为3.27%。在DAMA的原因中，较高比例与个人问题（39.04%）和前往其他中心（34.93%）有关，最低比例与对医生的不满（3.08%）有关。年龄组（19 - 37岁，OR = 2.17）、（38 - 56岁，OR = 1.70）和（57 - 75岁，OR = 1.62）、性别（男性，OR = 1.47）、地点（德黑兰市，OR = 0.61）和（德黑兰省，OR = 0.63）是DAMA的预测因素（p < 0.05）。
DAMA的重要性要求采取切实可行的措施，如为患者营造适宜的环境、为年轻人提供咨询服务、改善工作人员关系、为有需要的患者提供帮助以及解决患者及其陪伴人员的住宿问题，以降低DAMA发生率。
