Global Health

Yale-CORE China Project

Overview

The Yale-CORE China Project's mission is to improve health and health care through international friendship, research-generation, and knowledge application. We strive to leverage the strengths of the US and China, through partnership and friendship, to foster meaningful collaboration and mutual understanding-and promote medical and public health advances. We are committed to expanding the scientific knowledge base, accelerating medical breakthroughs and cures, and sharing our findings with a global audience so that what we learn may benefit our countries and the world.

Yale CORE China Project

The Yale-New Haven Hospital's Center for Outcomes Research and Evaluation (CORE) and the Chinese National Center for Cardiovascular Diseases (NCCD) began their landmark collaboration in 2010. Since then, the two sides have come together to form a strong team that serves as a bridge between two of the world's leading countries. The collaboration has yielded several groundbreaking national studies in China and over 20 academic publications in the last two years alone, many appearing in the premier journals in their fields. Our work has brought together dozens of leading scholars in medicine, biostatistics, and epidemiology, with hundreds of on-site coordinators and administrators; involved the study of hundreds of thousands of participating patients; and is serving as a foundation for health reform and quality improvement efforts across China.

About China PEACE

The China Patient-Centered Evaluative Assessment of Cardiac Events (China PEACE) is a national network of more than 200 hospitals-spanning almost every province and autonomous region in China-that participates in research designed, managed, and disseminated by our international team. The hospital network has been involved in building numerous patient registries that can be used to answer important questions about trends and outcomes in cardiovascular care in China. It is also being used to launch one of the first multi-center text message-based mobile health interventions in China and has anchored one of the world's largest population-based studies of cardiovascular disease. More details regarding China PEACE can be found at www.clinicaltrials.gov. Please see Current Projects for an overview of the studies that have leveraged the China PEACE national network, and related research projects currently underway.

Our Partnership


Current Projects

Cardiology Registries

Cardiology- Retrospective Registry: PEACE I

Ischemic heart disease is an issue of great public health importance in China. As the country continues to grow economically, it faces an epidemiological transition with rising mortality due to non-communicable diseases. The first study from the China PEACE network formed the foundation for our work in China. This study built a retrospective registry of Chinese patients from 200 hospitals to find out more about trends in acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) over the last decade. Over 18,000 medical records were abstracted at three time points-2001, 2006, and 2011-to provide a nationally representative sample of patients who were discharged with a diagnosis of AMI or who had a PCI procedure in hospital. We identified large increases in the estimated national rate of hospitalization for ST-segment elevation myocardial infarction (STEMI), a growing burden of prevalent cardiovascular risk factors, persistent delays in admission to hospitals, and significant gaps in the quality of care provided to patients across China. Our team has published over 15 papers in-high-impact journals such as The Lancet from this study alone. This foundational study has since informed and inspired our work to elevate the quality of care in China and improve patient outcomes.

Cardiology- Prospective Registry

To find out more about patients' experiences after hospitalization in China for AMI and PCI, we built on the success of our retrospective registry with the PEACE prospective registries for AMI and PCI. Since 2013, just under 10,000 patients have been enrolled and followed for 12 months after their first hospitalization for AMI or PCI. An unprecedented aspect of the registries is their focus on patient-reported outcomes collected at key time points across those 12 months, through phone and face-to-face interviews. By examining patients' clinical outcomes, as well as their own reported outcomes such as their health status, depression, stress and health-related quality of life, we hope to be able to describe their experiences and care trajectories in more meaningful detail.

Mobile Health Interventions

China PEACE-III Cardiovascular Health and Texting (CHAT) Study

Our team is uniquely positioned to harness China's growing entrepreneurial spirit in the field of e-and mHealth to improve the country's health system and outcomes. A new, patient-centered mHealth texting intervention-The China PEACE-III Cardiovascular Health and Texting (CHAT) Study-will be launched in the summer of 2016, where high-risk patients will receive texts encouraging them to live more heart-healthy lives. In this intervention, we will target factors such as high rates of smoking, lack of physical activity and high blood pressure.

QingDao Port Study

The Qingdao Port Cardiovascular Health Study marked Yale CORE and the Chinese NCCD's first foray into population-based health studies. In collaboration with the Qingdao Port Group, a large company based in the northeastern coastal city of Qingdao, over 32,000 employees of the port group have been studied from 2000 through 2013. In bringing together data collected from annual health assessments and biospecimen analyses over many years, the project has important resemblances to the Whitehall Study from the UK. Findings from preliminary and published work suggest that China's working-age population has experienced a dramatic increase in cardiovascular risk factors, including hypertension, hyperlipidemia, diabetes, and high body mass index. For more information about the QingDao Port Study, click here.

Millions Persons Project (MPP)

The team's most ambitious initiative to-date is the Millions Persons Project (MPP), which will leverage our experience with patient registries to collect important health data from 4 million people across China, making it one of the world's largest academic population-based studies. China is in the midst of a historic and monumental demographic transition: driven in large part by rapid economic growth, its population is becoming increasingly old and decreasingly rural. This has contributed to a dramatic rise in chronic and non-communicable diseases, especially cardiovascular diseases. The pilot study for the MPP was recently completed in 2015 after collecting information on 0.4 million people from 4 provinces (Jilin, Liaoning, Zhejiang, Guangxi), and the study continues to expand toward its final goal of 4 million participants in all provinces. To read more about the Millions Persons Project, click here.

Chronic Disease Registries

The China PEACE V: Chronic Disease Registries initiative will build upon the knowledge and experience we have generated in our previous studies by constructing five new chronic disease registries. The registries will enroll patients who have experienced stroke, chronic kidney disease, diabetes, heart failure, and valvular heart disease. Our team will lead the design and construction of the registries on heart failure and valvular heart disease while serving as a consultant on the others.

The Lancet Commission for Primary Healthcare

In the past, The Lancet has launched commissions on climate change, medical education, HIV/AIDS, and planetary health, with an aim to place a spotlight on neglected, emerging, or seminal topics in global public health. A newly announced Lancet Commission led by one of our team's leaders, Prof. Lixin Jiang from the NCCD, will inform future policy and research on primary care in China. This is an incredibly important topic in China, which currently lacks a functioning primary care system. Most care in the country is delivered in hospitals, where space, resources, and clinical care teams are increasingly stretched. The rise of non-communicable and chronic diseases in China necessitates a change, and the government has started to invest heavily in village and community health centers to develop a more proactive and responsive primary care system. However, there is a lack of consensus on what China's primary care system could and should look like. Our commission will involve partnerships with a number of leading health experts from the US and China to define the scope of the issue and offer recommendations and potential solutions. The end product of the 18-month commission will be a 25-30,000 document with profound academic and policy impacts. For a comprehensive overview of our collaboration's work, please click here.