factors affecting discharge against medical advice in a teaching hospital in shiraz, iran

introduction: patient/customer satisfaction and loyalty have gained increasing attention from executives across the healthcare industry. discharge against medical advice (dama) can be considered as one of the indicators of patient dissatisfaction. it has negative effects on patient treatment and leads to increased hospital costs. study of predictors of dama in a teaching hospital was the aim of this research. methods: in this retrospective, case-control study during the winter if 2009, a total of 9463 discharged patient medical records were reviewed. they were selected based on kind of discharge using systematic sampling. data was analyzed using chi-square test and t-test and binary regression in spss. results: overall, 9% of discharges in this period were against medical advices. there were significant associations between dama and health insurance status, hospital wards, and kind of disease. emergency ward patients and patients with no health insurance were more likely to dama. conclusion: high rate of dama should be considered by hospital managers. they should try to find out the causes of dama to prevent it and finally improve satisfaction and loyalty of patients.