Institutional Factors Affecting Organ Donation Rates

描述(申请人提供)：这项研究将考察环境和组织因素在多大程度上影响潜在器官捐赠者的数量和医院实际对潜在捐赠者转化率的变化。这项研究试图找出医院在器官捐赠者潜力和捐赠者转化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，医院潜在捐赠者的数量和捐赠者转化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，这些力量中的每一个都可以使用医院级、器官采购组织级和捐赠者服务区级的变量来运作。这项研究将是一个为期4年的纵向小组设计，将使用五个大型二级数据库进行：医疗保健成本和利用项目的全州住院患者出院数据库；器官共享联合网络数据库；美国医院协会数据库；区域资源文件；以及医疗保健组织认证联合委员会。将使用结构方程建模方法进行分析。验证性因素分析将用于衡量作为制度理论的三个理论结构的指标的每个变量的适宜性。潜在增长曲线分析将被用来确定不同类型医院潜在捐赠者的增长率和捐赠者转化率随时间的差异，以及体制因素如何影响这些增长率。这项研究将有助于对医院一级影响器官捐赠的因素进行非常有限的实证研究。它将向政策制定者通报对医院潜在捐赠者群体和捐赠者转化率最重要的影响，以便未来旨在增加美国器官捐赠者数量的立法倡议可以针对最有能力应对这些影响的医院。

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.