Association between hospital admissions and healthcare provider communication for individuals with sickle cell disease

Figures & data

Table 1. Socio-demographics and standard measures for participants with sickle cell disease.

Variable		Combined	Adults	Children^a
		(N = 542)	(N = 211)	(N = 331)
Age (Years)	Mean (SD, Range)	17.9 (13.2, 0–70)	30.7 (12.1, 18–70)	9.8 (4.6, 0–17)
Sex	Male	252 (46.5%)^b	91 (43.1%)	161 (48.6%)
	Female	290 (53.5%)	120 (56.9%)	170 (51.4%)
Race/Ethnicity	Black, African American, African, or Afro-Caribbean	527 (97.2%)	203 (96.2%)	324 (97.9%)
	Hispanic, Latino, or Spanish origin	10 (1.9%)	5 (2.4%)	5 (1.5%)
	Some other race or origin	19 (3.5%)	10 (4.7%)	9 (2.7%)
Highest degree or level of school completed	High school graduate or less	224 (41.3%)	90 (42.7%)	134 (40.5%)
	Some college or beyond	242 (44.7%)	116 (55.0%)	126 (38.1%)
Household size	Median (Range)	4 (1–5)	3 (1–5)	4 (1–5)
Marital status	Married or living together	165 (30.4%)	54 (25.6%)	111 (33.5%)
	Separate or unmarried	377 (69.6%)	157 (74.4%)	220 (66.5%)
Spirituality/Religiosity	Not very spiritual	316 (58.3%)	136 (64.5%)	180 (54.4%)
	Very spiritual	226 (41.7%)	75 (35.6%)	151 (45.6%)
Difficulty paying monthly bills	Not very or not at all difficult	293 (54.1%)	117 (55.5%)	176 (53.2%)
	Very or somewhat difficult	247 (45.6%)	93 (44.1%)	154 (46.5%)
Site	Midwest region:
	Cincinnati Children's Hospital Medical Center	51 (9.4%)	11 (5.2%)	40 (12.1%)
	Lurie Children's Hospital of Chicago	101 (18.6%)	17 (8.1%)	84 (25.4%)
	Western region:
	University of California San Francisco Benioff Children's Hospital Oakland	47 (8.7%)	47 (22.3%)	0 (0.0%)
	Mid-South region:
	Memphis (St. Jude Children's Research Hospital)	162 (29.9%)	6 (2.8%)	156 (47.1%)
	Memphis(^cUTHSC)	47 (8.7%)	47 (22.3%)	0 (0.0%)
	Nashville (Vanderbilt University Medical Center)	134 (24.7%)	83 (39.3%)	51 (15.4%)
Patient Health Questionnaire	Mean (SD)	1.08 (1.41)	1.46 (1.55)	0.84 (1.26)
ENRICHD Social Support Instrument (ESSI)	Poor	78 (14.4%)	47 (22.3%)	31 (9.4%)
	Good	464 (85.6%)	164 (77.7%)	300 (90.6%)
Brief Health Literacy Screening	Poor	136 (25.1%)	61 (28.9%)	75 (22.7%)
	Good	406 (74.9%)	150 (71.1%)	256 (77.3%)

^aCaregivers were asked to report for their children under 18 years, except for Highest degree or level of school completed, marital status, spirituality/religiosity, and difficulty paying monthly bills.

^bPercentages may not add up to 100% because of missing data.

^cUTHSC = University of Tennessee Health Science Center.

Table 2. Item descriptive statistics and CFA factor loadings, for provider communication and shared decisionmaking.

Domain	CAHPS Item	Mean	SD	N(%)				Factor Loading
				Never	Sometimes	Usually	Always
Provider Communication	In the last 12 months, did the sickle cell disease doctor …
	explain things in a way that was easy to understand	3.81	0.50	4	13	63	442	0.919
				(0.7%)	(2.4%)	(11.6%)	(81.6%)
	listen carefully to you	3.78	0.55	3	24	60	435	0.94
				(0.6%)	(4.4%)	(11.1%)	(80.3%)
	show respect for what you had to say	3.84	0.50	5	13	45	459	0.959
				(0.9%)	(2.4%)	(8.3%)	(84.7%)
	spend enough time with you (or your child)	3.70	0.60	5	24	94	399	0.911
				(0.9%)	(4.4%)	(17.3%)	(73.6%)
Shared Decision Making	In the last 12 months, did the doctor or other health provider …			Definitely no	Somewhat no	Somewhat yes	Definitely yes
	talk with you about the pros and cons of each choice for treatment or health care	3.44	0.94	47	21	100	341	0.911
				(8.7%)	(3.9%)	(18.5%)	(62.9%)
	ask which choice you thought was best for you (or your child)	3.44	0.95	48	24	92	346	0.933
				(8.9%)	(4.4%)	(17.0%)	(63.8%)

Table 3. Logistic regression models for hospital admission, readmission, and missed appointment.

Hospital Admission
Combined model (N = 508)
Variable		OR	95% CI	p value
Provider Communication		0.54	(0.35, 0.83)	0.005**
Shared Decision-Making		1.25	(1.00, 1.57)	0.054
Age		1.03	(1.01, 1.05)	0.004**
Sex (Ref = Male)	Female	0.99	(0.68, 1.44)	0.950
African American (Ref = No)	Yes	1.93	(0.34, 10.93)	0.460
Other race (Ref = No)	Yes	0.80	(0.23, 2.82)	0.728
Hispanic (Ref = No)	Yes	1.83	(0.24, 14.07)	0.560
Education (Ref = Some college or more)	High school or less	0.74	(0.48, 1.14)	0.169
	Missing	1.89	(1.02, 3.52)	0.045*
Difficulty paying monthly bills (Ref = Very or somewhat difficult)	Not very or not at all difficult	0.80	(0.54, 1.18)	0.251
Marital Status (Ref=Separate or unmarried)	Married or living together	1.33	(0.85, 2.08)	0.207
Household size		0.77	(0.64, 0.92)	0.004**
PHQ score		1.34	(1.15, 1.56)	<0.001**
Spirituality (Ref = Very spiritual)	Not very spiritual	1.13	(0.76, 1.68)	0.557
Social support (Ref=Poor)	Good	0.93	(0.51, 1.70)	0.805
Health literacy (Ref=Poor)	Good	0.97	(0.61, 1.54)	0.898
Adult model (N=175)
Variable		OR	95% CI	p value
Provider Communication		0.57	(0.27, 1.21)	0.146
Shared Decision Making		1.49	(0.88, 2.52)	0.138
Age		1.00	(0.96, 1.03)	0.819
Sex (Ref = Male)	Female	0.77	(0.37, 1.61)	0.490
Education (Ref = Some college or more)	High school or less	1.69	(0.81, 3.52)	0.159
Difficulty paying monthly bills (Ref = Very or somewhat difficult)	Not very or not at all difficult	0.37	(0.17, 0.81)	0.013*
Marital Status (Ref=Separate or unmarried)	Married or living together	1.87	(0.79, 4.41)	0.154
Household size		0.78	(0.58, 1.04)	0.086
PHQ score		1.34	(1.02, 1.77)	0.037*
Spirituality (Ref = Very spiritual)	Not very spiritual	0.97	(0.45, 2.09)	0.938
Social support (Ref=Poor)	Good	1.16	(0.45, 3.04)	0.758
Health literacy (Ref=Poor)	Good	1.60	(0.70, 3.65)	0.269
Pediatric model (N=330)
Variable		OR	95% CI	p value
Provider Communication		0.54	(0.31, 0.94)	0.029*
Shared Decision Making		1.18	(0.91, 1.54)	0.219
Age		1.01	(0.96, 1.06)	0.848
Sex (Ref = Male)	Female	0.98	(0.62, 1.56)	0.938
Education (Ref = Some college or more)	High school or less	0.92	(0.53, 1.58)	0.751
	Missing	1.98	(1.02, 3.84)	0.045*
Difficulty paying monthly bills (Ref = Very or somewhat difficult)	Not very or not at all difficult	0.99	(0.62, 1.58)	0.959
Marital Status (Ref=Separate or unmarried)	Married or living together	1.26	(0.73, 2.16)	0.412
Household size		0.81	(0.64, 1.03)	0.084
PHQ score		1.29	(1.06, 1.56)	0.010**
Spirituality (Ref = Very spiritual)	Not very spiritual	1.00	(0.62, 1.62)	0.998
Social support (Ref=Poor)	Good	0.90	(0.39, 2.07)	0.802
Health literacy (Ref=Poor)	Good	0.81	(0.45, 1.45)	0.484
Hospital Readmission
Combined model (N=507)
Variable		OR	95% CI	p value
Provider Communication		0.61	(0.36, 1.04)	0.070
Shared Decision Making		1.38	(0.95, 2.00)	0.090
Age		1.04	(1.01, 1.06)	0.002**
Sex (Ref = Male)	Female	1.23	(0.73, 2.08)	0.431
African American (Ref = No)	Yes	1.22	(0.19, 7.91)	0.836
Other race (Ref = No)	Yes	2.02	(0.46, 8.78)	0.351
Hispanic (Ref = No)	Yes	2.14	(0.31, 14.84)	0.442
Education (Ref = Some college or more)	High school or less	0.96	(0.54, 1.69)	0.876
	Missing	1.00	(0.41, 2.47)	0.999
Difficulty paying monthly bills (Ref = Very or somewhat difficult)	Not very or not at all difficult	0.57	(0.34, 0.97)	0.038*
Marital Status (Ref=Separate or unmarried)	Married or living together	0.98	(0.54, 1.80)	0.959
Household size		0.95	(0.76, 1.18)	0.628
PHQ score		1.33	(1.12, 1.58)	0.001**
Spirituality (Ref = Very spiritual)	Not very spiritual	0.72	(0.42, 1.23)	0.230
Social support (Ref=Poor)	Good	0.60	(0.30, 1.19)	0.146
Health literacy (Ref=Poor)	Good	1.25	(0.67, 2.33)	0.478
Adult model (N=174)
Variable		OR	95% CI	p value
Provider Communication		1.16	(0.47, 2.88)	0.743
Shared Decision Making		1.13	(0.63, 2.03)	0.674
Age		0.98	(0.94, 1.02)	0.266
Sex (Ref = Male)	Female	1.60	(0.72, 3.54)	0.247
Education (Ref = Some college or more)	High school or less	1.00	(0.46, 2.19)	0.999
Difficulty paying monthly bills (Ref = Very or somewhat difficult)	Not very or not at all difficult	0.28	(0.13, 0.63)	0.002**
Marital Status (Ref=Separate or unmarried)	Married or living together	1.71	(0.73, 4.01)	0.218
Household size		0.81	(0.60, 1.10)	0.176
PHQ score		1.35	(1.04, 1.75)	0.026*
Spirituality (Ref = Very spiritual)	Not very spiritual	0.35	(0.15, 0.81)	0.013*
Social support (Ref=Poor)	Good	0.59	(0.23, 1.49)	0.263
Health literacy (Ref=Poor)	Good	1.12	(0.46, 2.69)	0.808
Pediatric model (N=330)
Variable		OR	95% CI	p value
Provider Communication		0.23	(0.09, 0.57)	0.002**
Shared Decision Making		2.38	(1.04, 5.43)	0.040*
Age		0.98	(0.89, 1.07)	0.626
Sex (Ref = Male)	Female	0.87	(0.38, 1.96)	0.729
Education (Ref = Some college or more)	High school or less	1.12	(0.42, 3.00)	0.817
	Missing	1.58	(0.51, 4.90)	0.429
Difficulty paying monthly bills (Ref = Very or somewhat difficult)	Not very or not at all difficult	1.32	(0.58, 3.02)	0.514
Marital Status (Ref=Separate or unmarried)	Married or living together	0.64	(0.23, 1.80)	0.401
Household size		1.56	(0.99, 2.47)	0.057
PHQ score		1.38	(1.04, 1.84)	0.027*
Spirituality (Ref = Very spiritual)	Not very spiritual	1.09	(0.46, 2.58)	0.845
Social support (Ref=Poor)	Good	0.88	(0.21, 3.76)	0.867
Health literacy (Ref=Poor)	Good	2.11	(0.69, 6.50)	0.193
Missed Appointment
Combined model (N=508)
Variable		OR	95% CI	p value
Provider Communication		0.66	(0.37, 1.17)	0.157
Shared Decision Making		1.04	(0.81, 1.33)	0.772
Age		1.04	(1.01, 1.06)	0.002**
Sex (Ref = Male)	Female	1.03	(0.65, 1.61)	0.916
African American (Ref = No)	Yes	0.35	(0.04, 2.92)	0.329
Other race (Ref = No)	Yes	0.46	(0.12, 1.81)	0.263
Hispanic (Ref = No)	Yes	0.54	(0.06, 4.55)	0.567
Education (Ref = Some college or more)	High school or less	1.28	(0.77, 2.11)	0.344
	Missing	1.94	(0.90, 4.18)	0.090
Difficulty paying monthly bills (Ref = Very or somewhat difficult)	Not very or not at all difficult	0.65	(0.40, 1.03)	0.067
Marital Status (Ref=Separate or unmarried)	Married or living together	0.65	(0.40, 1.08)	0.095
Household size		0.98	(0.79, 1.22)	0.869
PHQ score		0.95	(0.80, 1.13)	0.590
Spirituality (Ref = Very spiritual)	Not very spiritual	1.74	(1.10, 2.77)	0.019*
Social support (Ref=Poor)	Good	0.64	(0.29, 1.42)	0.272
Health literacy (Ref=Poor)	Good	1.27	(0.72, 2.24)	0.405
Adult model (N=175)
Variable		OR	95% CI	p value
Provider Communication		1.86	(0.46, 7.59)	0.388
Shared Decision Making		0.32	(0.07, 1.48)	0.143
Age		0.97	(0.92, 1.02)	0.228
Sex (Ref = Male)	Female	0.76	(0.21, 2.78)	0.676
Education (Ref = Some college or more)	High school or less	0.53	(0.14, 2.04)	0.358
Difficulty paying monthly bills (Ref = Very or somewhat difficult)	Not very or not at all difficult	0.23	(0.05, 1.11)	0.068
Marital Status (Ref=Separate or unmarried)	Married or living together	1.12	(0.28, 4.54)	0.872
Household size		0.90	(0.54, 1.51)	0.693
PHQ score		0.98	(0.65, 1.49)	0.921
Spirituality (Ref = Very spiritual)	Not very spiritual	1.93	(0.53, 6.99)	0.317
Social support (Ref=Poor)	Good	0.32	(0.03, 3.26)	0.335
Health literacy (Ref=Poor)	Good	4.78	(1.18, 19.41)	0.029*
Pediatric model (N=330)
Variable		OR	95% CI	p value
Provider Communication		0.69	(0.36, 1.30)	0.248
Shared Decision Making		1.04	(0.80, 1.37)	0.760
Age		0.98	(0.93, 1.04)	0.442
Sex (Ref = Male)	Female	1.15	(0.69, 1.92)	0.585
Education (Ref = Some college or more)	High school or less	1.34	(0.75, 2.38)	0.321
	Missing	1.85	(0.86, 3.99)	0.118
Difficulty paying monthly bills (Ref = Very or somewhat difficult)	Not very or not at all difficult	0.66	(0.39, 1.11)	0.115
Marital Status (Ref=Separate or unmarried)	Married or living together	0.57	(0.32, 1.01)	0.052
Household size		1.15	(0.89, 1.48)	0.300
PHQ score		0.87	(0.71, 1.06)	0.167
Spirituality (Ref = Very spiritual)	Not very spiritual	1.38	(0.82, 2.33)	0.227
Social support (Ref=Poor)	Good	1.03	(0.41, 2.59)	0.943
Health literacy (Ref=Poor)	Good	0.91	(0.47, 1.78)	0.778

Note: Pediatric model reflects caregivers’ responses about their children.

Table 4. Linear regression model for each of the three health literacy items.

		Confidence filling out medical form			Help reading health-related materials			Problem learning medical condition
Combined model (N = 508)
Variable		B^a	95% CI	p value	B	95% CI	p value	B	95% CI	p value
Provider Communication		−0.01	(−0.22, 0.20)	0.956	−0.18	(−0.44, 0.07)	0.158	−0.28	(−0.46, −0.10)	0.003**
Shared Decision Making		0.06	(−0.05, 0.18)	0.270	0.02	(−0.11, 0.16)	0.734	−0.02	(−0.12, 0.08)	0.685
Age		−0.01	(−0.02, 0.00)	0.113	0.01	(0.00, 0.02)	0.273	0.01	(0.00, 0.01)	0.114
Sex (Ref = Male)	Female	0.13	(−0.06, 0.33)	0.178	−0.11	(−0.34, 0.13)	0.365	−0.06	(−0.23, 0.11)	0.488
African American (Ref = No)	Yes	0.03	(−0.82, 0.88)	0.949	0.21	(−0.82, 1.23)	0.692	−0.78	(−1.51, −0.05)	0.037*
Other race (Ref = No)	Yes	0.05	(−0.59, 0.70)	0.870	0.71	(−0.07, 1.49)	0.076	0.02	(−0.53, 0.58)	0.935
Hispanic (Ref = No)	Yes	0.12	(−0.80, 1.04)	0.801	0.23	(−0.88, 1.34)	0.681	−0.70	(−1.49, 0.10)	0.085
Education (Ref = Some college or more)	High school or less	−0.49	(−0.70, −0.27)	<.0001***	0.63	(0.37, 0.88)	<.0001***	0.32	(0.13, 0.50)	0.001**
	Missing	−0.75	(−1.07, −0.44)	<.0001***	1.08	(0.70, 1.46)	<.0001***	0.48	(0.21, 0.75)	0.001**
Difficulty paying monthly bills (Ref = Very or somewhat difficult)	Not very or not at all difficult	0.15	(−0.05, 0.35)	0.142	−0.02	(−0.26, 0.22)	0.881	−0.03	(−0.21, 0.14)	0.690
Marital Status (Ref=Separate or unmarried)	Married or living together	0.28	(0.05, 0.50)	0.016*	−0.07	(−0.34, 0.20)	0.615	−0.05	(−0.24, 0.14)	0.599
Household size		0.03	(−0.06, 0.12)	0.461	−0.03	(−0.14, 0.07)	0.532	−0.06	(−0.14, 0.01)	0.113
PHQ score		−0.04	(−0.12, 0.03)	0.259	0.06	(−0.03, 0.15)	0.174	0.03	(−0.03, 0.09)	0.350
Spirituality (Ref = Very spiritual)	Not very spiritual	−0.11	(−0.31, 0.09)	0.292	0.16	(−0.09, 0.41)	0.202	0.13	(−0.04, 0.31)	0.139
Social support (Ref=Poor)	Good	0.60	(0.30, 0.90)	<.0001***	0.08	(−0.28, 0.43)	0.675	0.00	(−0.26, 0.25)	0.986
Adult model (N=178)
Variable		B	95% CI	p value	B	95% CI	p value	B	95% CI	p value
Provider Communication		−0.13	(−0.44, 0.18)	0.398	−0.02	(−0.45, 0.42)	0.937	−0.36	(−0.70, −0.02)	0.037*
Shared Decision Making		0.16	(−0.06, 0.39)	0.156	−0.23	(−0.55, 0.08)	0.149	0.01	(−0.23, 0.25)	0.931
Age		−0.01	(−0.02, 0.01)	0.268	0.00	(−0.02, 0.02)	0.930	0.01	(−0.01, 0.02)	0.351
Sex (Ref = Male)	Female	0.41	(0.10, 0.71)	0.010*	−0.43	(−0.86, 0.01)	0.053	−0.24	(−0.57, 0.09)	0.159
African American (Ref = No)	Yes	−0.20	(−1.27, 0.87)	0.714	0.53	(−0.97, 2.04)	0.484	−0.28	(−1.44, 0.89)	0.640
Other race (Ref = No)	Yes	−0.09	(−0.97, 0.79)	0.838	0.63	(−0.61, 1.87)	0.320	0.39	(−0.57, 1.34)	0.428
Hispanic (Ref = No)	Yes	−0.48	(−1.59, 0.63)	0.397	0.86	(−0.70, 2.42)	0.276	0.12	(−1.08, 1.32)	0.842
Education (Ref = Some college or more)	High school or less	−0.36	(−0.66, −0.05)	0.022*	0.24	(−0.19, 0.66)	0.278	0.22	(−0.11, 0.55)	0.191
	Missing	−0.71	(−1.92, 0.51)	0.252	1.46	(−0.25, 3.17)	0.093	0.77	(−0.55, 2.09)	0.253
Difficulty paying monthly bills (Ref = Very or somewhat difficult)	Not very or not at all difficult	0.72	(0.41, 1.03)	<.0001***	−0.13	(−0.57, 0.30)	0.551	−0.46	(−0.80, −0.12)	0.008**
Marital Status (Ref=Separate or unmarried)	Married or living together	0.34	(0.00, 0.68)	0.052	−0.17	(−0.65, 0.31)	0.496	−0.03	(−0.40, 0.34)	0.875
Household size		−0.04	(−0.16, 0.08)	0.493	0.05	(−0.12, 0.22)	0.553	−0.02	(−0.15, 0.11)	0.742
PHQ score		0.05	(−0.06, 0.15)	0.360	−0.02	(−0.17, 0.12)	0.747	−0.01	(−0.13, 0.10)	0.811
Spirituality (Ref = Very spiritual)	Not very spiritual	−0.11	(−0.44, 0.21)	0.493	0.13	(−0.33, 0.59)	0.581	0.04	(−0.31, 0.39)	0.822
Social support (Ref=Poor)	Good	0.12	(−0.26, 0.51)	0.527	0.14	(−0.40, 0.68)	0.611	0.09	(−0.33, 0.50)	0.688
Pediatric model (N=330)
Variable		B	95% CI	p value	B	95% CI	p value	B	95% CI	p value
Provider Communication		0.07	(−0.22, 0.37)	0.625	−0.18	(−0.52, 0.16)	0.296	−0.20	(−0.43, 0.03)	0.084
Shared Decision Making		0.01	(−0.13, 0.15)	0.869	0.08	(−0.08, 0.24)	0.346	−0.03	(−0.13, 0.08)	0.641
Age		−0.02	(−0.04, 0.01)	0.276	0.00	(−0.03, 0.04)	0.820	0.00	(−0.02, 0.02)	0.841
Sex (Ref = Male)	Female	0.08	(−0.17, 0.33)	0.542	0.02	(−0.27, 0.31)	0.912	−0.03	(−0.22, 0.17)	0.788
African American (Ref = No)	Yes	0.20	(−1.15, 1.54)	0.775	−0.09	(−1.63, 1.45)	0.906	−1.43	(−2.46, −0.39)	0.007**
Other race (Ref = No)	Yes	0.35	(−0.56, 1.26)	0.453	0.79	(−0.26, 1.84)	0.140	−0.35	(−1.05, 0.36)	0.333
Hispanic (Ref = No)	Yes	0.53	(−0.96, 2.02)	0.486	−0.60	(−2.32, 1.11)	0.488	−1.61	(−2.76, −0.46)	0.006**
Education (Ref = Some college or more)	High school or less	−0.50	(−0.79, −0.21)	0.001**	0.85	(0.52, 1.18)	<.0001***	0.35	(0.13, 0.58)	0.002**
	Missing	−0.81	(−1.18, −0.45)	<.0001***	1.22	(0.80, 1.64)	<.0001***	0.47	(0.18, 0.75)	0.001**
Difficulty paying monthly bills (Ref = Very or somewhat difficult)	Not very or not at all difficult	−0.07	(−0.33, 0.19)	0.593	−0.03	(−0.33, 0.26)	0.824	0.18	(−0.02, 0.37)	0.083
Marital Status (Ref=Separate or unmarried)	Married or living together	0.23	(−0.06, 0.52)	0.125	0.01	(−0.33, 0.35)	0.945	−0.09	(−0.32, 0.13)	0.425
Household size		0.09	(−0.04, 0.22)	0.174	−0.07	(−0.22, 0.07)	0.321	−0.09	(−0.19, 0.01)	0.064
PHQ score		−0.08	(−0.18, 0.03)	0.150	0.06	(−0.06, 0.17)	0.353	0.04	(−0.04, 0.12)	0.319
Spirituality (Ref = Very spiritual)	Not very spiritual	−0.11	(−0.38, 0.15)	0.394	0.13	(−0.18, 0.43)	0.417	0.17	(−0.04, 0.37)	0.107
Social support (Ref=Poor)	Good	1.04	(0.59, 1.48)	<.0001***	−0.01	(−0.52, 0.50)	0.981	0.06	(−0.28, 0.40)	0.738

^aB = regression coefficient.