Date of Award

1-1-2013

Document Type

Thesis

Degree Name

Master of Arts (MA)

Specialization

Communication and Leadership

School or Department

School of Leadership Studies

First Advisor

Dr. John Caputo

Abstract

America's underserved are turning to emergency departments for non-urgent care at an alarming rate that is attracting national attention in an era of health reform, and prompting hospitals to offer patient assistance programs to help members of this patient population find other affordable care alternatives in the community. This study examined one such program, and the problem it is incurring with patients who continue to return to the emergency department despite receiving assistance. Moving away from the positivistic research norm found in literature, dialogic theory in the phenomenological tradition was used to investigate the lived experiences of patients being assisted by the program to better understand the social factors that lead them to return to the emergency department for non-urgent care. Ten qualitative interviews were held with uninsured and Medi-Cal-insured patients, and a thematic analysis of the data was conducted. Four themes emerged that revealed participants are returning to emergency departments due to the harsh realities of a failing Medi-Cal system, major gaps in community health center capability, a substandard public transit system, and because the emergency department is viewed as one institution where illness is still taken seriously within a health care system that no longer cares. Results of this study were incongruent with existing literature, and emphasize the need for further dialogic research to provide insight and understanding from a holistic patient perspective, which is critical to effectively serving the health care needs of vulnerable populations.

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