Cumulative health-related social needs burden and post-hospitalization emergency department use among medicaid and dual-eligible adults enrolled in transitional care a mixed methods study Jennifer Henderson

Format:

Book

Thesis/Dissertation

Author/Creator:

Henderson, Jennifer, author.

Contributor:

University of Pennsylvania. Nursing., degree granting institution.

Language:

English

Subjects (All):

Nursing.

Health sciences.

0569.

0566.

0769.

Local Subjects:

Nursing.

Health sciences.

0569.

0566.

0769.

Genre:

Academic theses

Physical Description:

1 online resource (165 pages)

Contained In:

Dissertations Abstracts International 87-12B

Place of Publication:

Ann Arbor : ProQuest Dissertations and Theses, 2026

Language Note:

English

Summary:

Emergency department visits remain disproportionately high among Medicaid-insured and dual-eligible populations, particularly following hospitalization. Transitional care interventions have been designed to support patients during this critical post-hospitalization period. Social determinants of health are increasingly recognized as key drivers of post-hospitalization outcomes. A core function of THRIVE, a nurse-led transitional care program that provides comprehensive care management for Medicaid and dual-eligible beneficiaries following hospital discharge, is to assess and address health-related social needs during the 30-day post- hospitalization period. To date, no studies have examined how cumulative health-related social needs burden influences emergency department utilization within a transitional care intervention or whether certain social needs warrant prioritization during the critical post-discharge period. This dissertation employs an explanatory sequential mixed methods design to examine the association between individual and cumulative health-related social needs and 30-day emergency department visits among participants enrolled in THRIVE. The quantitative phase included a retrospective cohort analysis (N=654 patient encounters) using multivariable logistic regression and machine learning approaches. The qualitative phase included semi-structured interviews (N = 10) exploring participants' post-hospitalization experiences to better understand how health-related social needs intersected with clinical recovery and care navigation during the 30-day transitional period. Interviews were analyzed using thematic analysis informed by the Healthy People 2030 Social Determinants of Health and Health Equity Implementation Frameworks. Quantitative and qualitative findings were then integrated to explain observed associations and identify opportunities to strengthen transitional care delivery. Findings from the quantitative phase reveal that cumulative health-related social needs burden was significantly associated with 30-day emergency department use among THRIVE participants, with each additional social need being associated with a 22% increase in the odds of experiencing an ED visit within 30-days following hospital discharge (OR = 1.22, 95% CI: 1.08-1.38, p < .01). Individual health-related social needs, including social support need, medication access barriers, and health literacy emerged as top predictors of ED utilization. Qualitative interviews further illuminated how unmet social needs impacted clinical recovery, with participants describing cascading barriers to medication access and care navigation, gaps in provider communication and discharge comprehension, and a profound loss of autonomy, identity, and agency during the post-discharge period. Future research should evaluate the utility of measuring cumulative HRSN burden when assessing risk within transitional care programs, broaden perspectives to include providers and caregivers, investigate the integration of psychosocial readiness screening into transitional care intake processes, and examine the use of precision-informed risk stratification tools that see patients in their full complexity. This study adds to the growing research on equity-focused transitional care by providing evidence on how the cumulative burden of health-related social needs influences post-hospitalization outcomes among Medicaid and dual-eligible populations, a group that has been largely underrepresented in transitional care research despite facing significant social risks and healthcare challenges

Notes:

Source: Dissertations Abstracts International, Volume: 87-12, Section: B.

Advisors: Brooks Carthon, J. Margo Committee members: McHugh, Matthew D.; Lake, Eileen T.

Ph.D. University of Pennsylvania 2026

Vendor supplied data

Local Notes:

School code: 0175

ISBN:

9798247983002

Access Restriction:

Restricted for use by site license