title: Analyzing Determinants of Hospitals' Accountable Care Organizations Participation: A Resource Dependency Theory Perspective.
abstract: Accountable care organizations (ACOs) are rapidly being implemented across the United States, but little is known about what environmental and organizational factors are associated with hospital participation in ACOs. Using resource dependency theory, this study examines external environmental characteristics and organizational characteristics that relate to hospital participation in Medicare ACOs. Results indicate hospitals operating in more munificent environments (as measured by income per capita: β = 0.00002, p < .05) and more competitive environments (as measured by Health Maintenance Organization penetration: β = 1.86, p < .01) are more likely to participate in ACOs. Organizational characteristics including hospital ownership, health care system membership, electronic health records implementation, hospital type, percentage of Medicaid inpatient discharge, and number of nursing home beds per 1,000 population over 65 are also related to ACO participation. Should the anticipated benefits of ACOs be realized, findings from this study can guide strategies to encourage hospitals that have not gotten involved in ACOs.
authors.affiliation: Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA vayeager@tulane.edu.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Yeager
authors.affiliation: Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
authors.forename: Yongkang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Diana
mesh_terms: D060866:Accountable Care Organizations; D003659:Decision Making, Organizational; D006761:Hospitals; D007407:Interviews as Topic; D006278:Medicare; D009936:Organizational Innovation; D011787:Quality of Health Care; D014481:United States
keywords: Accountable Care Organization (ACO); environment; health care quality; resource dependency theory