Patient-Level and Physician-level Predictors of Discharge Against Medical Advice: A Multilevel Modeling Approach
| Author | Amin Talebpour | en |
| Author | Homayoun Sadeghi-Bazargani | en |
| Author | Ali Jannati | en |
| Author | Hossein Hosseinifard | en |
| Author | Masumeh Gholizadeh | en |
| Orcid | Amin Talebpour [0000-0002-4338-3422] | en |
| Orcid | Homayoun Sadeghi-Bazargani [0000-0002-0396-8709] | en |
| Orcid | Ali Jannati [0000-0002-2302-9311] | en |
| Orcid | Hossein Hosseinifard [0000-0003-1308-1244] | en |
| Orcid | Masumeh Gholizadeh [0000-0002-0740-4302] | en |
| Issued Date | 2024-05-31 | en |
| Abstract | Background: Discharge Against Medical Advice (DAMA) is a complex and multifaceted issue in healthcare, often challenging the continuity of care and affecting patient outcomes. Objectives: This study aimed to investigate the predictors of Discharge Against Medical Advice (DAMA) by simultaneously examining patient- and physician-level variables within a unified analytical framework. Methods: This cross-sectional study was conducted in 2023 at one of the largest private hospitals in northwest Iran. The study included all 16,071 patients admitted in 2022 and 137 attending physicians. A multilevel analysis model was employed to examine the influence of variables related to patients and physicians in predicting DAMA. Results: The study involved patients with a mean age of 45.28 ± 19.59 years, with 67.7% being women and 14.8% not having health insurance. Among the physicians studied, the mean age was 56.27 ± 12.29 years, with 67.2% being male and 70.1% being hospital shareholders. Patients with DAMA comprised 6.8% (n = 1094). The null model had a log-likelihood value of -3304.90. When patient-level predictors were added, the value increased to -3041.76, a statistically significant improvement (P < 0.001) based on the chi-square test. Subsequently, incorporating physician-level predictors further increased the log-likelihood value to -2996.16, and this increase was also statistically significant compared to the model with only patient-level predictors (P < 0.001). Physician-level factors, including specialization, sex, and experience, were associated with DAMA. Significant patient-level variables included age, type of insurance, and type of disease (P < 0.05). Conclusions: Utilizing multilevel modeling enables the assessment of the significance of both physician-level and patient-level factors. To avoid conflicting results, it is recommended to evaluate hospital performance based on DAMA by considering both levels. | en |
| DOI | https://doi.org/10.5812/healthscope-145131 | en |
| Keyword | DAMA | en |
| Keyword | Inpatient | en |
| Keyword | Multilevel Analysis | en |
| Keyword | Private Hospital | en |
| Keyword | Iran | en |
| Publisher | Brieflands | en |
| Title | Patient-Level and Physician-level Predictors of Discharge Against Medical Advice: A Multilevel Modeling Approach | en |
| Type | Research Article | en |
Files
Original bundle
1 - 1 of 1
Loading...
- Name:
- healthscope-13-2-145131-publish-pdf.pdf
- Size:
- 140.17 KB
- Format:
- Adobe Portable Document Format
- Description:
- Article/s PDF