Dissertation/Thesis Abstract

The Hidden Healing of Hot-Spotting: Addressing Structural Vulnerability at the Ground Level
by Haas, Alysa Dupuy, M.A., University of Colorado at Denver, 2014, 87; 1563560
Abstract (Summary)

It has been shown on both local and national scales in the US that there is a small number of people whose healthcare costs make up a significantly disproportionate amount of total healthcare costs. Much of the costs that these "high-utilizers of care" incur come from emergency department visits and inpatient hospital admissions for health problems that would be treated more economically by primary and specialist care. Numerous "hot-spotting" intervention programs have been created over the last decade in attempts to both lower costs and improve the quality of care and health outcomes of "high-utilizers" by actively connecting patients with the existing primary and specialist care system and the social services system. Initial quantitative analyses have shown that this approach appears to largely accomplish these aims. However, there is a need for complementary research that seeks to understand the processes behind such important outcomes.

This study takes a closer look at one program's process of connecting patients to services, using "structural vulnerability" theory to frame its findings. Qualitative data from open-ended, semi-structured interviews with 17 participants (including patients, patient family members, program staff, and healthcare providers) were coded using qualitative analysis software. Resulting themes are used to first describe the problems faced by both patients and providers, emphasizing how these problems are exacerbated or caused by structural factors. Second, the program's process of connecting patients and providers is illustrated, paying particular attention to themes that showed discrepancies in participant responses and that point to the existence of incidental services provided by outreach workers. Ultimately, results show how the connection process is more than simply training patients and providers to work together, but in fact requires bandaging and sometimes healing "structural wounds" and other systemic problems before productive connections can be made and sustained.

Indexing (document details)
Advisor: Brett, John
Commitee: Horton, Sarah, Koester, Stephen
School: University of Colorado at Denver
Department: Anthropology
School Location: United States -- Colorado
Source: MAI 53/05M(E), Masters Abstracts International
Source Type: DISSERTATION
Subjects: Cultural anthropology, Health care management
Keywords: Complex care needs, Health care, High-utilizers, Structural violence, Structural vulnerability
Publication Number: 1563560
ISBN: 9781321132168
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