Date of Award

Summer 7-8-2025

Embargo Period

7-15-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Nursing Science

Department

Nursing

College

College of Nursing

First Advisor

Teresa Kelechi

Second Advisor

Martha Sylvia

Third Advisor

Martina Mueller

Fourth Advisor

Mary Naylor

Abstract

Purpose: This study examined how Self-Reported Health (ratings), a person’s own evaluation of their overall health, relates to hospital admissions and emergency department utilization. It further assessed the extent to which demographic characteristics, Risk Adjustment Factor (RAF) scores (used to estimate healthcare expenditures based on clinical complexity), and the number of chronic conditions influence SRH rating and the likelihood of hospitalization.

Problem and Aim: The growing population of older adults places greater demands on healthcare services, leading to increased financial strain and a need for improved care strategies. Primary care teams, particularly those managing older adults, require effective assessment methods to identify and mitigate the risk of hospitalization promptly. This dissertation highlights the potential of SRH ratings as such a method, proposing that it provides critical insights into patients' health that are not captured by clinical and diagnostic tests.

Design: This research included an integrated review and two non-experimental retrospective secondary data analyses. The frameworks guiding this research included Whittemore and Knafl's model for the integrative review and McLeroy's Social Ecological Model (SEM) for organizing the literature. Andersen’s Behavioral Model of Health Service Use guided the secondary data analyses, providing a framework to examine the factors influencing individuals’ access to and utilization of healthcare services, specifically ED visits and hospitalizations.

Results: Findings indicated that poorer SRH ratings is significantly associated with higher hospitalizations, particularly when combined with a higher number of chronic conditions and specific demographic indicators. Additionally, the relationship between SRH ratings and RAF scores varies, with a positive SRH rating potentially reducing the impact of high RAF scores on hospitalization risk and increasing medical costs.

Conclusion: The study highlights the necessity of integrating subjective SRH ratings assessments with objective health evaluations to enhance the accuracy of assessing patients for risk of ED visits, hospitalizations, and a deterioration in health status. Integrating SRH ratings into routine clinical evaluations and risk models can help healthcare teams identify at-risk individuals more effectively, allowing for targeted interventions that could reduce hospitalizations and foster a more individualized approach to health management.

Rights

Copyright is held by the author. All rights reserved.

Download

Share

COinS