The Impact of Housing Instability and Transportation Insecurity on COPD Hospital Readmissions in Vulnerable Populations
Abstract/Description/Artist Statement
Problem Statement Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of morbidity and healthcare utilization in the United States, accounting for approximately $50 billion in annual healthcare costs, with $13.2 billion linked specifically to readmissions. Despite the Hospital Readmissions Reduction Program (HRRP) targeting COPD as a key quality metric, 30-day readmission rates remain high at 22.6%. African Americans disproportionately experience worse COPD outcomes, including higher hospitalization rates and a slower decline in mortality. While social determinants of health (SDOH) are known to influence health outcomes, there is limited research analyzing the dual impact of housing instability and transportation insecurity on readmission rates in this specific population. This study sought to investigate how these nonmedical factors contribute to 30-day readmissions to inform targeted discharge planning and policy interventions aimed at improving health equity.
Methodology This study employed a non-experimental, causal-comparative retrospective data chart review. A convenience sample of 100 African American adults (ages 25–85; mean age 63.3) with a documented diagnosis of COPD was selected from a Level 1 Trauma tertiary hospital in Virginia. The study site serves a population where over 25% of African Americans live below the poverty line, making it an ideal setting for SDOH research. Using the Social Determinants of Health Framework, the study focused on the "Neighborhood and Built Environment" domain. De-identified data from electronic health records (2020–2024) were extracted to assess the independent variables of housing instability and transportation insecurity against the dependent variable of 30-day COPD readmission. Data were analyzed using IBM SPSS 26.0, utilizing descriptive statistics and chi-square tests to determine significant differences between groups.
Results and Significance Within the sample, 27% of patients reported housing instability and 26% reported transportation insecurity. Patients experiencing these barriers had a 30-day readmission rate of 25.6%, compared to a 22.9% readmission rate for those with stable housing and transportation. Statistical analysis using chi-square tests yielded p-values of 0.784 for housing and 0.508 for transportation, indicating that the differences were not statistically significant within this sample size (N=100).
While the study failed to reject the null hypothesis, the raw data shows a slightly higher readmission percentage for the unstable group, suggesting that a larger sample size might reveal more pronounced trends. These findings underscore the clinical importance of implementing SDOH screening tools and developing transitional care programs that address environmental barriers. The study serves as a foundation for refining healthcare policies and resource allocation strategies to reduce disparities and improve the quality of life for vulnerable COPD populations.
Faculty Advisor/Mentor
Dr. Janice Hawkins
Faculty Advisor/Mentor Email
jhawkins@odu.edu
College/School Affiliation
Ellmer School of Nursing
Student Level Group
Graduate/Professional
Presentation Type
Poster
The Impact of Housing Instability and Transportation Insecurity on COPD Hospital Readmissions in Vulnerable Populations
Problem Statement Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of morbidity and healthcare utilization in the United States, accounting for approximately $50 billion in annual healthcare costs, with $13.2 billion linked specifically to readmissions. Despite the Hospital Readmissions Reduction Program (HRRP) targeting COPD as a key quality metric, 30-day readmission rates remain high at 22.6%. African Americans disproportionately experience worse COPD outcomes, including higher hospitalization rates and a slower decline in mortality. While social determinants of health (SDOH) are known to influence health outcomes, there is limited research analyzing the dual impact of housing instability and transportation insecurity on readmission rates in this specific population. This study sought to investigate how these nonmedical factors contribute to 30-day readmissions to inform targeted discharge planning and policy interventions aimed at improving health equity.
Methodology This study employed a non-experimental, causal-comparative retrospective data chart review. A convenience sample of 100 African American adults (ages 25–85; mean age 63.3) with a documented diagnosis of COPD was selected from a Level 1 Trauma tertiary hospital in Virginia. The study site serves a population where over 25% of African Americans live below the poverty line, making it an ideal setting for SDOH research. Using the Social Determinants of Health Framework, the study focused on the "Neighborhood and Built Environment" domain. De-identified data from electronic health records (2020–2024) were extracted to assess the independent variables of housing instability and transportation insecurity against the dependent variable of 30-day COPD readmission. Data were analyzed using IBM SPSS 26.0, utilizing descriptive statistics and chi-square tests to determine significant differences between groups.
Results and Significance Within the sample, 27% of patients reported housing instability and 26% reported transportation insecurity. Patients experiencing these barriers had a 30-day readmission rate of 25.6%, compared to a 22.9% readmission rate for those with stable housing and transportation. Statistical analysis using chi-square tests yielded p-values of 0.784 for housing and 0.508 for transportation, indicating that the differences were not statistically significant within this sample size (N=100).
While the study failed to reject the null hypothesis, the raw data shows a slightly higher readmission percentage for the unstable group, suggesting that a larger sample size might reveal more pronounced trends. These findings underscore the clinical importance of implementing SDOH screening tools and developing transitional care programs that address environmental barriers. The study serves as a foundation for refining healthcare policies and resource allocation strategies to reduce disparities and improve the quality of life for vulnerable COPD populations.