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The Clinical Outcomes Research Center (CORC) is a joint venture of the Medical School and the School of Public Health at the University of Minnesota. Administratively housed now in the Medical School, it offers an opportunity for clinical research faculty to develop projects that address the outcomes of care. It is intended to generate sound information that relates the variations in the way health care is delivered to the outcomes of that care. It can become the basis for a model outcomes information system that will position the new entity as a modern health care activity. At the same time, it can also serve as a platform to improve the quality of care and to teach students at various levels clinical research techniques and how to assess the quality of evidence that supports medical decisions.
CORC as an Outcomes System
Within the CORC context, outcomes include both the traditional measures of survival and satisfaction as well as aspects of physical and social functioning and quality of life concerns. CORC’s outcomes include both disease-specific measures and more generic measures.
The dominant conceptual model for CORC’s work is an epidemiological approach, which uses analysis to separate the relationship between treatment and outcomes, adjusting for the roles of related patient characteristics. This reliance on epidemiology, however, does not imply that CORC does not pursue more structured randomized experiments. CORC’s methodological expertise lies in research design, conduct, and analysis and the selection and development of measures appropriate to clinical research. A core function of CORC is the development of prospective structured data systems that capture relevant baseline status and risk factors for specific clinical problems or therapies and the systematic collection of follow-up data to assess the outcomes in terms that capture both the clinical and the patient-centered effects of care.
CORC as an Outcomes Resource
CORC offers a core of technically-skilled professionals who can provide the requisite services to mount and maintain an outcomes research program. These skill areas include data collection (including survey design and conduct and record abstraction), measurement, sampling, and data analysis. CORC’s staff complement includes health services researchers, statisticians, economists, psychometricians, and survey experts. In addition, CORC staff include health professionals who can serve as effective liaisons between technical personnel and clinicians to assure that meaningful communication creates the best studies possible.
CORC’s Research Program
CORC has developed research projects at two levels. It has collaborated with local faculty to develop and improve specific research projects. For example, several projects have involved the development of quality of life measures specific to particular types of patients. Others have looked at the effectiveness of an aspect of care or a change in the way care was provided (e.g., guidelines). This was the mode in which CORC was designed to operate, matching its technical skill base with clinician researchers’ interest and insights in a given topic.
The second level of CORC activity has been the conduct of national studies. CORC staff are now engaged in a number of major efforts, which include the evaluation of demonstration projects involving care of persons dually covered by Medicare and Medicaid, the implementation of an outcomes information system for mental health and substance abuse treatment in a national managed behavioral care program with a specific focus on factors associated with the outcomes of alcohol treatment, and a project to link Medicare administrative data with clinical information collected directly from patients.
CORC has also collaborated with the School of Nursing to conduct an NIH funded intensive national training program in interdisciplinary outcomes research.
CORC’s Modus Operandi
CORC serves as a resource for faculty interested in outcomes research. It can function in two modes:
