Avoidable hospital readmissions continue to be a concerning and costly healthcare issue. While the emphasis on reducing avoidable hospital readmissions persists, incentivization strategies are evolving. Initial strategies prioritized medical care delivery, but recent regulation highlights the value of effective transitional (discharge) care planning, and particularly, patient involvement in that process. This latter aspect of care has a clear indication for the application of shared decision-making. Shared decision-making (SDM) practice in the acute care setting largely represents a gap in the literature; yet understanding patient perceptions of SDM during hospitalization is an important and timely first step in exploring the effectiveness of newly implemented regulation-driven hospital initiatives. The purpose of this study is to examine the relationships between perceptions of SDM during hospitalization, patient experience, and readmissions. This study utilized a prospective cohort design, including participant recruitment and survey distribution upon day of hospital discharge followed by an observation period to monitor for 30-day readmission. The target population was adults who were hospitalized for general medical conditions at a single community hospital. The final sample size was 83. Patient perceptions of SDM were measured using the CollaboRATE Measure of Shared Decision-Making, which was validated as part of this study. Study findings indicated that patients perceive the occurrence of SDM and participation in both care decisions and transitional planning. Most also agreed with their discharge disposition. Perceptions of SDM: varied based on patient, provider, and organizational factors during care decisions; varied based only on nurse communication during transitional care planning; were significantly related to hospital patient experience, as measured by HCAHPS subscales; were not found to be related to 30-day readmissions; however, patient agreement with discharge disposition was predictive of readmission. These findings were largely consistent with the proposed conceptual model and establish a foundation for future related research.


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Graduation Date





Unruh, Lynn


Doctor of Philosophy (Ph.D.)


College of Community Innovation and Education


School of Public Administration

Degree Program

Public Affairs; Health Services Management and Research




CFE0008989; DP0026322





Release Date

May 2023

Length of Campus-only Access

1 year

Access Status

Doctoral Dissertation (Open Access)