Higher SHFM scores were associated with more hospitalizations ( rate ratio per 1-unit increase , 1.86 ; P < .001 ) , more inpatient days ( 2.30 ; P < .001 ) , and higher inpatient costs ( 2.28 ; P < .001 ) , outpatient costs ( 1.54 ; P < .001 ) , and total medical costs ( 2.13 ; P < .001 ) .