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.