NHLBI Center for Cardiovascular Outcomes Research (CCOR) at Yale University


In 2010, the National Heart, Lung, and Blood Institute of the National Institutes of Health established a Center for Cardiovascular Outcomes Research at Yale University, one of three identified after a national competition. CCOR’s 4-year grant will provide the research infrastructure to develop a national surveillance program for cardiovascular care and outcomes. This will allow the opportunity to look at current care patterns and treatment outcomes, identify best practices, evaluate cost-effectiveness, and develop and refine tools for measuring outcomes. CCOR will also support scholarship with practical value to clinical practice and health care policy.

CCOR Project 1 – ENCORE Examining Novel Cardiovascular Outcomes and Regional Effects

We seek to better understand the patterns and systems of care that lead to improved patient outcomes through two allied projects. In the first project, which is built upon our existing Medicare database, we will pursue scholarship that characterizes top performance and its key determinants. We will harvest this data structure through collaborative research. ENCORE’s aims are as follows:

  1. To characterize hospital and regional (hospital referral region (HRR)) performance and patient-level outcomes, assess patient, organizational and regional time trends, and determine factors associated with performance and­ improvement, defined by the CMS publicly reported measures (AMI, HF, PCI and ICD), as well as other cardiovascular conditions, tests and procedures, cardiovascular risk factors and control conditions.
  2. To investigate hospital and regional performance and patient-level outcomes using novel measures that focus on a longer episode of care (1-year mortality measures for patients hospitalized with cardiovascular conditions, tests and procedures, cardiovascular risk factors and control conditions) and population-based hospitalization rates (HRR hospitalization rates for cardiovascular conditions and procedures, cardiovascular risk factors and control conditions).
  3. To characterize the costs of care for cardiovascular conditions and procedures, cardiovascular risk factors and control conditions, during the index hospitalization, in the first 30 days and 1 year after admission, and investigate how costs and payments relate to patient outcomes and hospital and regional performance (30-day and 1-year risk-standardized mortality and 30-day readmission).

CCOR Project 2 – TOP PCI Translating Outstanding Performance in Percutaneous Coronary Intervention

In the second project, we will use a mixed methods approach to supplement the findings of ENCORE with a deeper understanding of the key organizational strategies associated with exemplary outcomes for PCI patients. This study will utilize an existing limited dataset that combines administrative data from the Center for Medicare and Medicaid Services that has been linked with the American College of Cardiology National Cardiovascular Data Registry’s CathPCI Registry® to determine hospital performance. TOP PCI will begin with a qualitative component in which we visit top performing hospitals to identify candidate strategies, and will then move to a quantitative survey of PCI hospitals to determine which strategies are most closely associated with better patient outcomes.

Our hope is that the information we learn from this repository will increase our knowledge of hospital quality measures and that this information will help inform the medical community and establish evidence-based practices that promote better patient care and outcomes for patients undergoing PCI.