Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Caroline Etland, PhD, RN, AOCN, ACHPN, Committee Member; Laurie Ecoff, PhD, RN, NEA-BC, Committee Member


Food Insecure, Food Insecurity, COPD, Healthcare Utilization, Chronic Disease, Social Determinants of Health



Purposes/Aims: Despite advances in the recognition and treatment of high-cost users of health care, the incidence of healthcare utilization remains high. Rates of hospital admissions and emergency room visits among chronic disease like COPD have become a targeted group for health management. COPD patients have multiple and complex health and social needs, but the impact of their unmet food needs is not well understood and warrants further investigation. The purpose of this study is to explore the relationships between COPD food insecure patients and healthcare utilization in San Diego County.

Background/Rationale: Government programs targeting patients with high healthcare costs focus on clinical conditions, factors internal to the healthcare system and individual patient education. There has been recent interest in addressing modifiable social determinants of health (SDOH) with the intent of reducing health care utilization due to the modest impact of existing government programs. SDOH at the population level include access to healthy foods/good nutrition.

Conceptual Basis: If existing social programs that address food insecurity are used among those with COPD, we may experience downstream effect of decreased healthcare utilization, for example emergency room visits and hospital admissions.

Method: A descriptive correlational design using retrospective data was used. Data were abstracted from the electronic health records of patients receiving services for COPD. The purposive sample included patients 40 years or older with an ICD 10 code AECOPD upon discharge from the emergency room or their hospital admission. Descriptive and inferential statistical analyses were used to describe patient characteristics and examine relationships among multiple independent variables and two dependent variables.

Findings: Study included 854 cases and 42 cases were assessed as food insecure. Findings indicated a statistically significant association between patient’s FI status and ED visit and homelessness status. There were no significant age differences among the patients who had an ED visit or hospitalized (71.58-73.42). Male patients were less likely than females to have ED visits and patients who lived in the Southern zip codes area were more likely than those in the central or northern area to have ED visits.

Implications for Research: This study contributes to the growing body of research supporting the association of upstream social factors and how existing programs can be utilized effectively to have downstream health outcomes such as healthcare utilization.

Document Type

Dissertation: Open Access



Available for download on Thursday, May 04, 2023