title: Rate and Causes of Discharge against Medical Advice in Iranian Hospitals: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Discharge against Medical Advice (DAMA) is a problem for hospitals which may result in increasing readmissions, morbidities, inabilities, deaths and health care costs. This study, aimed to investigate the rate and causes of DAMA in Iranian hospitals.
  
  
  METHODS
  A systematic review and meta-analysis study was conducted in 2014. Required data were collected through searching for key words included: "Discharge Against Medical Advice", "Leaving against medical advice", "causes*", "hospital" and their Persian equivalents, over databases including PubMed, OVID, Google Scholar, Embase, Scopus, Magiran, scientific information database (SID). The reference lists of the articles, certain relevant journals and web sites in this field were also searched.
  
  
  RESULTS
  Out of 913 articles initially retrieved, finally 17 articles were incorporated into the study. There were 244858 individuals studied in the articles. Using a random effects model, the rate of DAMA in Iranian hospitals was estimated at 7.9% (6.3%-9.8%). While the highest rate of DAMA was associated with patients in departments of psychiatry (12%), the lowest rate was related to patients in departments of pediatrics (3.7). DAMA was in men more than women (P<0.05) Patient's perception of feeling of wellbeing, financial problems, family problems, the lack of attention from physicians and nurses, inappropriate behavior with patients by hospital team and the lack of timely care were mentioned as main causes for DAMA.
  
  
  CONCLUSIONS
  The rate of DAMA in Iranian hospitals is relatively high. Thus effective initiatives in this area are required.
authors.affiliation: Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Mohseni
authors.affiliation: School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mahtab
authors.initials: M
authors.lastname: Alikhani
authors.affiliation: School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Sogand
authors.initials: S
authors.lastname: Tourani
authors.affiliation: Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Saber
authors.initials: S
authors.lastname: Azami-Aghdash
authors.affiliation: School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Sanaz
authors.initials: S
authors.lastname: Royani
authors.affiliation: Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Moradi-Joo
keywords: Causes; Discharge; Iran; Meta-analysis; Rate; Systematic review