Reducing rates of discharge against medical advice in the neonatal intensive care unit in a tertiary care hospital in South India: A mixed methods study

摘要: OBJECTIVE To elucidate characteristics among neonates and their mothers who were discharged against medical advice (DAMA), providers' perspectives on DAMA the effect of an intervention to reduce in a tertiary care hospital South India. METHODS We conducted mixed-methods study identify at risk DAMA. reviewed charts logit regression analysis calculate adjusted odds ratios (aOR) 95% confidence intervals (CI) determine associations with focus group discussions nurses doctors. developed that included family counselling, supplemental funds for bills involving members RESULTS Of 10 834 neonates, 179 (1.7%) over period. Maternal associated higher previous parity (aOR 1.9, CI 1.1-2.3, P = 0.001). Mothers received antenatal had lower 0.2, 0.1-0.7, P = 0.039). Neonates birth weight 2.1, 1.7-9.4, P = 0.002) congenital malformations 3.3, 1.1-5.3, P = 0.005) also The most commonly cited reasons financial constraints, inadequate counselling perceived poor prognosis. average monthly number decreased from 3.6 (1.6%) 1.5 (0.6%) after our multi-pronged intervention. CONCLUSIONS severe illness prognosis A demonstrated reductions rates This may be trialled similar settings