Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA United States of America.
Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA United States of America.
Am J Med Sci. 2023 Jul;366(1):16-21. doi: 10.1016/j.amjms.2023.04.007. Epub 2023 Apr 18.
Discharge against medical advice (DAMA) represents an increasingly burdensome public health issue that leads to worse outcomes for patients and high costs to society. While the rate of patients who DAMA is higher within certain institutions and geographic locations, the problem is present across all healthcare systems. DAMAs are often challenging as they occur suddenly and can be unsatisfactory. An opportunity exists to better meet the needs of this patient population; however, many providers are unsure of how they can prevent a DAMA. In this review, we discuss the broader impact, associated factors, the most common reasons, the consequences, and the prevention strategies for DAMA. Further research is needed to create tools for stratifying patients most likely to DAMA. Early identification and appropriate interventions for these patients will allow for safe discharges.
擅自出院（DAMA）是一个日益严重的公共卫生问题，会导致患者的预后更差，并给社会带来高昂的成本。尽管某些医疗机构和地理位置的患者 DAMA 率更高，但这一问题在所有医疗保健系统中都存在。DAMA 往往具有挑战性，因为它们是突然发生的，而且可能令人不满意。现在有机会更好地满足这部分患者的需求；然而，许多提供者不确定如何预防 DAMA。在这篇综述中，我们讨论了 DAMA 的更广泛影响、相关因素、最常见的原因、后果以及预防策略。需要进一步的研究来创建工具，对最有可能 DAMA 的患者进行分层。早期识别和对这些患者的适当干预将允许安全出院。
