Graduation Semester and Year




Document Type


Degree Name

Doctor of Philosophy in Social Work


Social Work

First Advisor

Genevieve Graaf


This study reports the individual and county-level factors associated with racial and ethnic disparities in the ED and inpatient utilization rates and discharge status for adult individuals with chronic mental illness (CMI) and comorbid medical conditions. Social determinants at the individual and county levels associated with rates of higher risk discharge statuses, and the extent to which these account for heterogeneity in acute care utilization and post-acute care plans were also assessed. Despite the significant literature in racial and ethnic disparities, and emergency department and inpatient admission utilization, there remains gaps in the literature regarding individuals with chronic mental illness and medical condition comorbidities. Inferential analysis was based on multilevel mixed-effects logistic regression models to estimate the odds ratios (OR) for each discharge outcome focusing in particular on differences across racial groups. Nine multilevel mixed-effects logistic regression models were specified to include a random intercept to account for random effects across counties. The random effects account for the between-county variation due to county-specific contextual effects. Five models were specified corresponding to the five outcomes of interest in the patient dataset and an additional four models were specified corresponding to the four outcomes of interest in the outpatient dataset. Models controlled for the individual and county covariates listed above. This study found that the incidence of patients identified as Black, Asian or Pacific Islander, Other, or American Indian/Eskimo/Aleut had decreased odds of having high-risk discharges in outpatient settings. ED outcome results vary in significance and association. Inpatient utilization outcomes were similar in significance and association. The role of discharge planning in health care access and utilization is discussed further concentrating on high-risk discharges, challenges in discharge planning, disparities in discharge planning – including racial and ethnic disparities and eliminating health disparities among adults with comorbid mental and medical conditions is encompassed in Chapter 1. Chapter 2 then delves greater into disparities as well as the Gelberg-Andersen Behavioral Model for Vulnerable Populations. This chapter will provide an overview of historical individual and structural factors and consequences of these factors contributing to the disparities of this population. Chapter 3 describes the analytic methods used in this study, of the racial and ethnic disparities among the Texas ED and inpatient facilities. Study results are presented in Chapter 4 and Chapter 5 concludes with a discussion of findings and their implications for future research.




Social and Behavioral Sciences | Social Work


Degree granted by The University of Texas at Arlington

Available for download on Sunday, February 01, 2026

Included in

Social Work Commons