title: Prediction of onset and course of high hospital utilization in sickle cell disease.
abstract: BACKGROUND
  Although sickle cell disease (SCD) patients typically manage their pain at home, a small subgroup is frequently hospitalized and accounts for the majority of costs.
  
  
  OBJECTIVE
  1) To identify prospective diagnostic and demographic markers of new periods of high utilization; 2) To identify demographic and diagnostic markers of a persistent rather than moderating course of high utilization; 3) To replicate the finding that high utilization tends to moderate.
  
  
  METHODS
  The State Inpatient Databases for California, 2004-2007, were used. Patients with new onset periods of high utilization were compared with non-high utilizers, and new high utilizers who moderated were compared with those who had a persistent course.
  
  
  METHODS
  All hospitals in the state of California.
  
  
  METHODS
  Patients age 13 years or older in 2004 with a recorded diagnosis of sickle cell disease and at least one hospitalization for crisis during the study period.
  
  
  METHODS
  
  
  
  METHODS
  Groups from hospitals throughout California were compared on demographics and discharge diagnoses of SCD complications and comorbidities. Patients age 13 years or older in 2004 with a recorded diagnosis of sickle cell disease and at least 1 hospitalization for crisis during the study period were included.
  
  
  RESULTS
  New periods of high utilization were associated with more prior hospitalizations and previous diagnoses of aseptic necrosis and renal disease. High utilization typically moderated. A persistent course was associated with slightly more hospitalizations during the initial year of high utilization, and, subsequently, by more mentions of septicemia and mood disorders.
  
  
  CONCLUSIONS
  Overall, high utilization was difficult to predict, as was its course. The diagnoses most associated with high utilization indicated more severe sickle cell disease. Septicemia deserves further investigation as a preventable cause for high utilization, as do mood disorders.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA. docpat2511@yahoo.com
authors.forename: C Patrick
authors.initials: CP
authors.lastname: Carroll
authors.forename: Carlton
authors.initials: C
authors.lastname: Haywood
authors.forename: Sophie
authors.initials: S
authors.lastname: Lanzkron
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000453:epidemiology* / Q000628:therapy*; D002140:California / Q000453:epidemiology; D016208:Databases, Factual / Q000639:trends; D005260:Female; D005544:Forecasting; D006760:Hospitalization / Q000639:trends; D006761:Hospitals / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D011446:Prospective Studies; D055815:Young Adult