Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Administration

First Advisor

Jan Clement, Ph.D.

Second Advisor

Gloria Bazzoli, Ph.D.

Third Advisor

Susan Roseff, M.D.

Fourth Advisor

Leslie Stratton, Ph.D.


Blood transfusions are the most common hospital procedure. However, many transfusions may be unnecessary. These unnecessary transfusion may expose patients to the potential risks of transfusion without improving patient outcomes Patient blood management (PBM) programs emphasize conserving a patient’s own blood resources and only transfusing the minimum amount needed. This study examined the organizational and environmental factors associated with a hospital having a PBM program, or having processes based on PBM, and their impact on organizational and patient outcomes potentially affected by blood transfusions.

A PBM survey was created for this study and used to gather information on hospitals having a PBM program or having processes based on PBM. 150 responses were received. Several publicly available data sources were used to obtain the organizational and environmental factors used in this study, as well as the outcome measures potentially affected by blood transfusions. Resource Dependence Theory and Donabedian’s Structure-Process-Outcome framework were used to develop this study’s five hypotheses. Logistic, multivariate probit, and ordinary least square regressions were used to test the hypotheses.

The study’s findings suggest that competition and hospital size are associated with a higher likelihood of a hospital having a PBM program, while physician availability was associated with a higher probability of having some processes based on PBM. Having a PBM program was associated with better outcomes for 30-day readmission rates for hip and knee replacements, while length of PBM program experience was associated with lower Medicare spending per beneficiary.


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Available for download on Sunday, August 30, 2026