Date of Conferral

10-9-2026

Date of Award

October 2026

Degree

Ph.D.

School

Nursing

Advisor

Cara Krulewitch

Abstract

Chronic kidney disease (CKD) is the most prevalent non-communicable disease worldwide. Preventable hospitalizations accounted for $79 million in hospital spending costs for patients with CKD. Due to the 2025 Budget Reconciliation Act, millions are expected to lose their Medicaid coverage. Without insurance, individuals may have to rely on hospital care to manage CKD or, worse, go without care. The lack of access to preventive care in underserved populations with CKD and the impact of insurance coverage on preventable hospitalizations serve as the research problem. The purpose of this study, guided by Andersen’s behavioral model of health services, was to examine the relationship between the insurance type and race/ethnicity and the likelihood of preventable hospitalizations among underserved populations with CKD. The research questions were whether the insurance type and race/ethnicity predict the likelihood of preventable hospitalizations in populations with CKD. The research design was a quantitative retrospective that analyzed secondary data from AHRQ (n = 145,370), with inclusion criteria of individuals aged 18–64 with CKD Stages 1–4. Logistic regression in SPSS was used to analyze the data, and the key findings indicate that the insurance type and race/ethnicity are significant predictors of preventable hospitalizations. Recommendations for future research include using a dataset with state identifiers to compare Medicaid expansion and non-expansion states. Implications for positive social change include the importance of Medicaid expansion, research on social determinants of health and their effects on health outcomes, and the role of nurses in ensuring equitable care and advocacy.

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