Physical and mental health in adults hospitalized with sickle cell disease: impact on resource use.

BACKGROUND

It is commonly perceived that patients with sickle cell disease have increased hospital length of stay (LOS) because of mental health issues, including depression and drug-seeking behavior. However, the effect of mental and physical functional status on acute care resource use is unknown.

OBJECTIVE

To assess Short Form (SF)-12 physical and mental health scores in adults with sickle cell disease and their impact on hospital LOS and costs.

DESIGN

We identified 145 adults with sickle cell disease admitted to the general medicine ward at the University of Chicago Medical Center between July 1997 and June 2003. Seventy-nine patients (54%), with a total of 103 admissions, completed the SF-12 for at least one admission. Administrative data were used to obtain demographic information, LOS, and costs. Multivariate regression was used to measure the association between SF-12 physical and mental composite scores (by quartile), and LOS and costs.

RESULTS

Twenty-five percent of patients accounted for nearly 80% of total hospital days and costs. The mean SF-12 physical score was 40 (SD, 12), and mental score 49 (SD, 12). Adjusted for age, gender, race, and comorbidities, admissions in the lowest quartile of the SF-12 physical composite score had an average LOS of 7.11 days and costs of $9060, compared to 4.6 days and $5520 in the highest quartile (p < .03, < .05). The SF-12 mental compositive score was not significantly associated with LOS or costs.

CONCLUSIONS

Poor physical function rather than poor mental function independently predicts greater use of acute health care resources in adults with sickle cell disease.