CCOR

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

Overview

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 provided the research infrastructure to develop a national surveillance program for cardiovascular care and outcomes. This allowed 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 also supported scholarship with practical value to clinical practice and health care policy.

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

We sought to better understand the patterns and systems of care that lead to improved patient outcomes through two allied projects. In the first project, which was built upon our existing Medicare database, we will pursue scholarship that characterizes top performance and its key determinants. We harvested this data structure through collaborative research. ENCORE’s aims were 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 used 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 utilized an existing limited dataset that combined administrative data from the Center for Medicare and Medicaid Services that had been linked with the American College of Cardiology National Cardiovascular Data Registry’s CathPCI Registry® to determine hospital performance. TOP PCI began with a qualitative component in which we visited top performing hospitals to identify candidate strategies, and then moved to a quantitative survey of PCI hospitals to determine which strategies were more closely associated with better patient outcomes.

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

This was accomplished in two phases. First, we conducted in-depth qualitative interviews and site visits with 158 staff in 11 hospitals, including top and bottom performing hospitals based on risk-standardized 30-day mortality rates published by Centers for Medicare & Medicaid Services (CMS). Second, based on hypotheses generated by the qualitative study, we designed and implemented a web-based survey that was used to determine the associations between the identified hospital efforts and hospital risk-adjusted 30-day mortality rates for Medicare fee-for-service patients.

Our future goal is to collaborate with leading organizations to promote the national dissemination of our findings to improve hospital care for patients with AMI.