title: An examination of discharge against medical advice from brain injury inpatient rehabilitation.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Hospital discharge data from two national administrative databases were reviewed for the years 2001-2006.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Careful screening and assessment of patients who discharge AMA could enable better prevention and management strategies, thus improving health outcomes and enhancing healthcare delivery.
authors: Department of Occupational Therapy, College of Rehabilitation Sciences, Daegu University, Republic of Korea.
authors: Hwan
authors: H
authors: Kim
authors: Angela
authors: A
authors: Colantonio
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*