Analysis The Causes Of Discharge Against Medical Advice Of Children In Neonatal Department

Objective:To analyze the cause of neonatal unhealed discharged in neonatal department,so as to provide a reference basis for reducing the rate of unhealed discharge of neonates,effectively improving the level of neonatal treatment,and improving the prognosis of neonates.Methods:668 cases were collected on neonatal unhealed discharge from January 2010 to December 2015 in neonatal department,divided into uninsured group(273 cases)and insurance group(395 cases),to analyze the clinical date,cost and family economic conditions of.different time unhealed discharged in newborns.Results:1.The rate of neonatal unhealed discharge decreases(P<0.001),it decreases significantly after the implementation of neonatal insurance(P<0.001).2.Comparison before and after implementing the neonatal insurance,unhealed discharge rate decreases from 27.44%to 20.61%for gestational age<37 weeks(P<0.05)and decreases from 16.59%to 14.27%for gestational age>37 weeks(P>0,05%);the average hospitalization cost increases from 1165.83 yuan/day to 1220.25 yuan/day(P<0.05).3.Unhealed discharged neonatal outcome types,the proportion of improved neonatal outcomes increases from 62.64%to 75.21%,and the proportion of abandonment decreases from 30.40%to 16.46%,and the proportion of hospital transfer increased from 6.96%to 8.10%(P<0.001).The constituent ratio of premature infants and full term infants was compared before and after the implementation of the neonatal insurance,neonatal who gave up treatment was with premature newborns dominate(P>0.05);those who recovered,the proportion of premature infants decreases(42.11%vs 37.92%,P>0.05);but those who transferred,.the proportion of premature infants decreases(36.84%vs 9.83%,P<0.05).4.Comparing the common diseases of the neonatal unhealed discharge before and after implementing the neonatal insurance,the incidence of neonatal respiratory distress syndrome was significantly higher(9.63%vs 22.735,P<0.05).5.After implementing the neonatal insurance,transferring due to congenital malformations was significantly higher(43.75%vs 15.79%,P<0.05).Conclusion:1.The neonatal unhealed discharge rate decreases year by year,the neonatal insurance can reduce the rate of unhealed discharge.2.Because of the improvement is in the majority among those unhealed discharged infants.It is necessary to strengthen education on health keeping and promote communication between doctors and patients in order to reduce the rate of unhealed discharge.3.Neonatal disease severity,family economic conditions and neonatal insurance has effected neonatal the treatment.4.Neonatal insurance is helpful for treatment of premature infants,but abandonment treatment in preterm infants has nothing to do with insurance,the problem of prognosis may be the main reason to give up.5.Congenital malformation is the major cause of neonatal referral for treatment.Therefore it is needed to strengthened prenatal care and reduce the occurrence of birth-defect.