Project Title/Research Interests: Hospital Responses to the Emergency Medical Treatment and Labor Act (EMTALA): Noncompliance, Hospital Utilization and Readmissions, and Strategic Diversions

Health care laws to increase patient safety and access only work if organizations comply with them.  Understanding reasons behind noncompliance suggests how to target interventions for improving compliance.  Organizational theory, which focuses on factors like organizational context and external pressure to conform, expands the traditional “deterrence” model that focuses on costs/benefits of noncompliance. This dissertation studies organizational determinants of noncompliance with two federal health care laws.

First, the Food and Drug Administration Amendments Act (FDAAA) requires pharmaceutical clinical trials to register on a trial registry website and to post certain results after data collection completion.  The FDAAA intends to improve patient safety by mitigating selective outcome reporting, delays in publication of clinical trial results by sponsors, and publication bias, which lead physicians to overestimate pharmaceutical benefits.  Yet, compliance with the FDAAA remains low.  Because FDAAA compliance is not actively monitored and enforced, organizational context can play a critical role in predicting compliance.  Thus, we focus on whether organizational context, including the type of organization or the nature of the pharmaceutical trial, differentially impact timely registration and reporting of clinical trial results before and after the FDAAA.

Second, the Emergency Medical Treatment and Labor Act (EMTALA) requires most hospitals to appropriately screen, stabilize, or transfer uninsured patients.  Yet inappropriate transfers occur, particularly after 2003 regulations weakened EMTALA.  We explore the differential impact of not-for-profit status and the role of legitimacy pressures as drivers of potentially inappropriate patient transfers by hospitals before and after the 2003 regulations.