Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Administration

First Advisor

Dr. Gloria Bazzoli

Second Advisor

Dr. David Harless

Third Advisor

Dr. Jessica Mittler

Fourth Advisor

Dr. Patrick Shay


As the popularity of urgent care centers (UCCs) has grown, hospitals have increasingly chosen to invest in this care model. Hospital interest in UCCs is largely driven by two key factors. First, hospitals aim to use UCCs to generate referrals, which generate additional patient volume for downstream hospital services. Secondly, hospital UCC investment presents an opportunity to ease the demand for non-urgent care in the emergency department (ED) by diverting low-acuity ED patients to the more appropriate UCC setting. No study to date has evaluated the impact of hospital UCC investment on referrals or downstream service volumes. A few studies have examined the association between UCCs and ED visits, but these have produced mixed results and none have specifically focused on hospital-owned UCCs.

This study integrates Strategic Management Theory and Contingency Theory to conceptualize the relationship between hospital UCC investment and the volume of low-acuity ED visits, outpatient visits, and ambulatory surgeries. The study utilizes a retrospective, longitudinal panel study design with hospital-level data for years 2010 through 2015 from multiple public and private data sources. Poisson regression methodology and Ordinary Least Squares regression methodology are employed to test study hypotheses. Hospital UCC investment is not associated with a reduction in low-acuity ED visits, even when financial pressure and stressed ED capacity are included as moderators. This is an important consideration for hospital leaders and policy makers as they evaluate options for reducing ED pressure and redirecting low-acuity ED utilization to lower cost settings. However, hospital UCC investment is associated with increased outpatient visits and ambulatory surgeries for HMO owners in later years of UCC ownership. Thus, this study identifies UCC investment as a viable strategy for hospitals to retain/increase revenue and potentially gain competitive advantage by attracting patients to their UCC that would otherwise go to a competitor’s facility.


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