Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Administration

First Advisor

Yasar Ozcan


Healthcare-associated infections occur commonly in hospitals and have a major impact on patient well-being. The occurrence of the healthcare-associated infection, Clostridium difficile, has been occurring more frequently among hospitalized patients due to an epidemic strain, and is an important cause of antibiotic-associated diarrhea and colitis. This study examined the impact of several organizational factors on the occurrence of C. difficile infection (CDI) in hospitals using an institutional theory perspective. Administrative claims were utilized from University HealthSystem Consortium hospitals to obtain hospital-level data for the calendar year 2011. Data were available for 89 hospitals. Hospital-level analyses, negative binomial regression models, were conducted to test eight developed hypotheses and the associations between organizational factors and the incidence of CDI in hospitals. Cases of CDI were risk-adjusted for known factors associated with CDI. After controlling for factors known to be associated with CDI, the results of the analyses showed that one study hypothesis was supported. That is, hospitals with higher Leapfrog Group Safety Scores had CDI rates that were no different than hospitals with lower Safety Scores. Further, it was found that U.S. News and World Report Best Hospital Honor Roll member hospitals had significantly higher occurrence of CDI as compared to non-Honor Roll member hospitals, though it was predicted that there would be no difference in CDI rates. The organizational factors state-led CDI prevention collaboratives, state mandatory CDI reporting, Magnet status, the rate of central line-associated bloodstream infections and catheter-associated urinary tract infections, and CDI physician champions, were not significantly associated with CDI occurrence.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

May 2014