title: Frequency and trends of hospital discharges against medical advice (DAMA) in a large administrative database.
abstract: OBJECTIVE
  The aim of this research was to characterize hospitalizations associated with discharges against medical advice (DAMA) in a large, population-based data system.
  
  
  METHODS
  This was a retrospective cohort study on 11 436 500 hospital admissions. The hospital discharge records for residents of the Veneto region (north-east Italy) discharged from 2001 to 2012, from both public and accredited private hospitals, were considered. The DAMA rate was calculated by type of hospital admission, excluding patients who died. The time trend of the DAMA rate was charted from the average annual percent changes.
  
  
  RESULTS
  During the period considered, 66 549 DAMA were recorded, amounting to an overall DAMA rate of 6.0‰ admissions. Analyzing the diagnostic categories, admissions for substance abuse (drugs or alcohol) and dependence coincided with the highest DAMA rate (83.5‰), followed by poisoning (40.2‰), psychiatric disorders (24.7 ‰), traumas (21.1‰), HIV-related diseases (19.9‰), burns (10.5‰), and - for women - issues relating to pregnancy, childbirth and the postnatal period (11.2‰). The DAMA rate dropped from 6.72 to 5.55 from 2000 to 2008, then remained stable.
  
  
  CONCLUSIONS
  The DAMA rate dropped slightly over the period considered. Several diagnostic categories are associated with a higher likelihood of patients leaving hospital against their doctor's advice.
authors.affiliation: Area Sanità e Sociale, Regione Veneto, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Saia
authors.forename: Alessandra
authors.initials: A
authors.lastname: Buja
authors.forename: Domenico
authors.initials: D
authors.lastname: Mantoan
authors.forename: Chiara
authors.initials: C
authors.lastname: Bertoncello
authors.forename: Tatjana
authors.initials: T
authors.lastname: Baldovin
authors.forename: Giampietro
authors.initials: G
authors.lastname: Callegaro
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Baldo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003376:Counseling; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010351:Patient Discharge / Q000706:statistics & numerical data* / Q000639:trends; D011153:Population; D011247:Pregnancy; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult