Institutional Factors Affecting Organ Donation Rates

描述（由申请人提供）：本研究将考察环境和组织因素对医院潜在器官供体数量和实际到潜在供体转换率随时间变化的影响程度。本研究旨在找出医院在器官捐献潜力和捐献转换率方面存在差异的原因。制度理论是指导研究的组织理论。概念模型提出，医院的潜在供体数量及其供体转换率是医院环境中三种制度力量的函数：强制性、模仿性和规范性力量。该模型提出，每一种力量都可以使用医院级、器官采购组织级和供体服务区域级变量进行操作。该研究将是一项为期4年的纵向面板设计，并将使用五个大型二级数据库进行：卫生保健成本和利用项目的全州住院出院数据库；联合器官共享数据库网络；美国医院协会数据库；区域资源文件；以及医疗机构认证联合委员会。分析将使用结构方程建模方法进行。验证性因子分析将被应用于衡量每个变量的适用性，这些变量被选为制度理论的三个理论结构的指标。潜在增长曲线分析将用于确定不同类型医院的潜在献血者增长率和献血者转化率随时间的差异，以及制度因素如何影响这些增长率。本研究将有助于一个非常有限的实证研究机构，探讨影响医院层面器官捐赠的因素。它将告知政策制定者对医院潜在供体池和供体转换率的最重要影响，以便未来旨在增加美国器官供体数量的立法倡议可以针对最有能力对其作出反应的医院。

DESCRIPTION (provided by the applicant): This study will examine the degree to which environmental and organizational factors influence the change in the number of potential organ donors and the actual-to-potential donor conversion rate in hospitals over time. This study seeks to identify the reasons that hospitals differ in their organ donor potential and their donor conversion rate. Institutional theory is the organizational theory that will guide the research. The conceptual model proposes that a hospital's number of potential donors as well as its donor conversion rate is a function of 3 institutional forces within the hospital's environment: coercive, mimetic, and normative forces. The model proposes that each of these forces can be operationalized using hospital-level, organ procurement organization level, and donor service area-level variables. The study will be a 4-year longitudinal panel design and will be conducted using five large secondary databases: The Health Care Cost and Utilization Project's Statewide Inpatient Discharge database; the United Network for Organ Sharing database; the American Hospital Association database; the Area Resource File; and the Joint Commission on Accreditation of Healthcare Organizations. The analysis will be conducted using a structural equation modeling approach. Confirmatory factor analysis will be applied to measure the suitability of each of the variables chosen as indicators for the three theoretical constructs of institutional theory. Latent growth curve analysis will be employed to determine how growth rates of potential donors and donor conversion rates over time differ for different types of hospitals as well as how institutional factors influence these growth rates. This study will contribute to a very limited body of empirical research examining factors affecting organ donation at the hospital level. It will inform policy makers of the most important influences on hospitals' potential donor pools and donor conversion rates so that future legislative initiatives designed to increase the number of U.S. organ donors could target hospitals that are most capable of responding to them.