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Sickle cell disease (SCD) affects one of every 375 black babies born in the United States. The sickle shaped red blood cells of these patients increase blood viscosity, block blood vessels, and destroy tissue. SCD patients suffer from pain when their blood vessels are blocked, and they are susceptible to infection and serious complications such as stroke. Disease severity plays a primary role in determining the cost and duration of hospitalizations for SCD patients, according to a recent study supported by the Agency for Healthcare Research and Quality (HS09553 and National Research Service Award training grant T32 HS00032).
A research team led by Thomas R. Konrad, Ph.D., of the University of North Carolina at Chapel Hill, used a 1995 national sample of 6,249 SCD discharges from 183 not-for-profit hospitals to identify determinants of hospital resource use among patients with SCD. They linked clinical and cost discharge data with 1994 hospital survey data on hospital characteristics. The average total cost of hospital admission in this sample was $6,755, and Medicaid was the primary payer for the majority of admissions.
About 21 percent of patients had another major illness in addition to SCD, and the majority were admitted from emergency departments (EDs). Expected charges for a base-case individual without major existing illnesses in addition to SCD (comorbidities) totaled $4,029. Each additional comorbidity increased expected total charges by $1,000 or more, increased average daily charges by $100, and added three-quarters of a day to the expected hospital stay. Perhaps due to costs to stabilize them prior to admission, the expected total and average daily charges for patients admitted from the ED exceeded those of patients admitted from other settings by $446 and $1,081, respectively, but lengths of stay were comparable. Few hospital characteristics were associated with the three measures of hospital use examined. SCD management programs should maximize access to quality outpatient services to reduce reliance of SCD patients on expensive ED care, suggest the researchers.
See "Hospital resource utilization among patients with sickle cell disease," by Michelle L. Mayer, R.N., M.P.H., Ph.D., Dr. Konrad, and Christopher C. Dvorak, M.D., in the February 2003 Journal of Health Care for the Poor and Underserved 14(1), pp. 122-135.
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