Center for Care Organization Research & Development
CCORD is a collaborative organization of health services researchers within the University of Minnesota School of Public Health, Division of Health Policy and Management, and external partners. Our center integrates expertise in care organization, performance measurement and public reporting, along with incentive design and risk adjustment. We also provide expertise in quality management, systems management and organizational development.
We work closely with policymakers, health care managers, and health care providers to conduct research that provides an evidence base for the design and implementation of programs. In doing so, we extend theories of care organization to factor in the multiple and complex contexts in health care organizations.
This research focuses on the relationships and activities between actors and systems internal to health care organizations and health care provision teams.
Understanding and Implementing Care Teams: Building a Community of Practice
A grant from the University of Minnesota’s Institute for Advanced Study (IAS) is allowing CCORD to facilitate collaborative work, which proposes to build a community practice focused on care teams. This collaborative seeks to break down silos and encourage integration by sharing knowledge through presentations and meetings and encouraging the formation of research. This will facilitate identifying fundable care team research that will contribute to the improvement of health care, in the United States and in other countries, and extend our knowledge of how such teams can be effectively organized. As part of this work, CCORD is organizing an invitational meeting on Transforming Primary Care in the United States and England.
Improving Networks and Teamwork in Assertive Community Treatment Teams (INTACT)
This research examines the causes and consequences of a positive constructive context. The constructive context of a team, its positive affect, psychological safety, constructive controversy, and social capital facilitate care team improvement and adoption of evidence based practices. The research significantly extends prior research on teams because it focuses on the impact of social networks, the web of relationships (i.e., advice, trust, workflow, friendship ties) connecting team members. Social networks are likely to be particularly important causes of a constructive team context that supports the diffusion of clinical evidence based practices and the formation of high performance learning care teams.
This work was initially funded by the National Science Foundation and is continuing a collaboration with colleagues in the University of Minnesota Department of Sociology and Carlson School of Management.
Coordination of Care in Primary Health Care in the United Kingdom
The objective of this research is to identify the mechanisms by which practices seek to coordinate care for patients with multiple problems and the impact of these mechanisms on the quality and outcome of care. The findings will show how ant to what extent care coordination is necessary to high quality care; provide tools for measuring care coordination and its outcomes; and suggest ways in which care coordination may be improved, leading to better quality outcomes for patients.
This research is led by the National Primary Care Research and Development Centre (NPCRDC), Manchester, England.
Evaluation of Care Guides in the Primary Care Office
This study develops and tests the use of lay ‘care guides’ as patient care coordinators and organizers in primary care clinics. The goal is to develop an efficient, sustainable model for improving chronic disease outcomes. This study has expanded from a successful pilot located in one clinic to a randomized controlled trial in multiple clinics within the Allina Hospitals & Clinics system. This study is led by Dr. Richard Adair, Allina Hospitals & Clinics and Jon Christianson, PhD, and is funded by the Robina Foundation.
This research focuses on the functioning and design of provider payment and other incentives, and their risk adjustment at the health care system level.
Minnesota Health Care Home Payment Model & Technical Support
For this project, CCORD worked with stakeholders and the Minnesota Department of Human Services (DHS) to create a system for paying health care homes in a way that rewards stable, patient-centered, accountable care that results in improved health outcomes, appropriate utilization and lower cost. Payment is based on a model that uses a risk-stratified patient population. The payment model will be refined throughout the implementation of Health Care Homes in Minnesota, and a data exchange model and other needed Health Care Home management methods will be developed. This research is conducted through contract with the Minnesota Department of Human Services and led by Rob Kreiger, PhD.
Risk Adjustment for State Quality Measurement System
The goal of this project is to generate risk adjustment methodologies for the state quality measurement system in development by the Minnesota Department of Health. CCORD researchers review current quality measurement risk adjustment issues and consider how measures that have previously been accepted without risk adjustment may need to be revised in the context of possible public reporting or tying of measures to payment. CCORD additionally recommends risk adjustment methods that balance the need to advance performance measurement with the concern for fairness and provider acceptance. This research is conducted through subcontract with Minnesota Community Measurement and led by Doug Wholey, PhD.
This research focuses on measuring performance within and between health systems, developing accurate measures, and risk-adjusting measures.
Effects of Performance Measurement on Health Care Systems
This is a qualitative study, which examines and creates a typology of effects of performance measures on primary care providers and staff in primary care, including unintended consequences of performance measurement. This study is conducted with the Veterans Health Administration and led at the University of Minnesota by Kathleen White.
This research focuses on readiness for change, change processes, factors that encourage and incent change within health care systems, and evaluating the effectiveness of organization change efforts.
Multidisciplinary Organization and Outcomes for Chronic Heart Failure Patients in the Veterans Health Administration
This study tests a theory of the effect of nurse-physician co-leadership, the effective modeling by nurses and physicians of individual role behaviors and a strong shared inter-professional relationship, in chronic heart failure (CHF) care groups in Veterans Health Administration (VHA) medical centers. Main findings show that co-leadership causes close working relationships in heart failure care, which contributes to staff psychological safety and improvement in care outcomes. This research is led by Douglas Wholey and Joanne Disch of the School of Nursing at the University of Minnesota, conducted in collaboration with the Veterans Health Administration, and supported by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative.
Wholey and Disch presented results from this study at the INQRI annual meeting in 2010. Watch their presentation.
This research focuses on measuring and improving the quality and efficiency of care provided in health systems.
Comparing Cost-effectiveness of traditional fee-for-services Medicare and Medicare Advantage chronic illness care using NCQA Relative Resource Measures
This project compares the technical efficiency of care–a measure that links resource inputs with quality outcomes–for chronically ill Medicare Advantage (MA) and fee-for-service (FFS) beneficiaries. In particular, the research will: 1) validate that the new HEDIS Relative Resource Use (RRU) measures can be applied to FFS, and; 2) compare RRUs in FFS and MA plans within geographic areas. The objective of the project is to provide policymakers with more information about the factors that contribute to efficiency and to identify the relative strengths of MA and FFS for chronically ill beneficiaries. This project is led by Beth Virnig and supported by funding from the Robert Wood Johnson Foundation’s Program in Health Care Financing and Organization.
The Relationship between Chronic Illness Care Quality and Current and Future Resource Use: An application of NCQA’s HEDIS Relative Resource Use (RRU) and Quality Measures, a presentation discussing preliminary results of this research, was given at the Academy Health Annual Research Meeting in June 2010 by David Knutson and Schelomo Marmor. View the presentation slides.
Examining the Relationships of State Offices of Minority Health to Internal and External Stakeholders
This project studies organizational and other characteristics of state offices of minority health. The study uses interviews and a survey to construct case studies of individual state offices and to describe the networks of partners that state offices of minority health engage. This project is led by Dr. Peggy Honore and has been supported in part by funding from the Robert Wood Johnson Foundation.
Our research integrates five main topic areas that are foundational for designing effective care delivery. The research focuses on database management and analytics, including both quantitative and qualitative methods, that supports mix methods research.
Wholey is an expert in organizations, management, systems analysis and health care business intelligence. He has extensive skills in inter- and intra-organizational networks and social network analysis; survey development, data management, and analysis; and statistical analysis including multilevel modeling and propensity score analysis.
He has conducted research on professional teams in health care, the social structure of markets, managed care markets and organizations, public health systems, social service and health networks, information systems, and software teams.
He has been awarded the Robert Wood Johnson Foundation’s award for outstanding work in the field of Public Health Systems and Services research in 2009, and is a Professor of Health Policy and Management at the University of Minnesota.
Christianson has substantial experience in conducting large evaluations, particularly projects that combine qualitative and quantitative data analyses, and is an expert at evaluation and analysis at the community systems level.
He has conducted research on quality measurement and reporting, health insurance, financial incentives in healthcare, development of new consumer-directed health plans, employer strategies for purchasing healthcare, implementation of evidence-based treatment processes in healthcare organizations, and tracking change in healthcare markets.
He sits on the Institute of Medicine Board on Health Care Services and is the James A. Hamilton Chair in Health Policy and Management at the University of Minnesota.
White is a specialist in organizational development, multi-sectoral leadership, and qualitative and focus group analysis. She spent the first part of her career as a health care executive and management consultant.
She has conducted research on understanding change and its effects in health care organizations at the individual, team, and organizational levels. She holds a doctorate in organization development and is a Research Associate and leadership teacher at the University of Minnesota.
Kreiger specializes in data strategy (aligning measurement systems with organizational objectives), systems analysis, and health care business intelligence.
He has extensive experience in performance measurement, physician profiling, risk adjustment, care delivery system modeling, claims data processing, informatics, and program evaluation. He has completed work in quantitative and qualitative healthcare data analysis, measurement development, study design, and result interpretation; and outcomes analysis on functional status, quality of life, survey, and cost metrics.
His current work focuses on modeling options for the delivery of care coordination to selected target populations. He is a Research Associate at the University of Minnesota.
CCORD researchers and collaborators are national leaders in health services research and in the disciplinary areas that provide a research foundation for health care organization. These areas include organizational theory, medical practice management, economics, sociology, and statistics.
Center for Care Organization Research & Development
420 Delaware Street SE, MMC 729
Minneapolis, Minnesota, 55455
Lindsay Grude, Research Coordinator
D527 Mayo Building
CCORD prioritizes work that:
- Integrates theory and practice
- Advances the state of the art in methods and theory
- Improves our partners’ capabilities
- Strengthens the foundation of care organization research and practice
Our goal is to improve patient and population health through integrating research and practice to advance transformational knowledge about health care systems and care delivery.
CCORD and Allina Researchers Receive Innovation Award
CCORD and Allina Hospitals and Clinics researchers received a HealthPartners Innovation in Health Care Award in 2011. This award recognizes cutting-edge approaches aimed at improving health, patient experience, and controlling the cost of care.
The team received the award for their research into effectively using lay persons to support chronic disease care through a randomized controlled trial of lay care guides in Allina primary care clinics.
CCORD researchers, led by Principal Investigator Jon Christianson, are evaluating the randomized trial of care guides using mixed methods including qualitative inquiry and quantitative analysis of economic and health outcomes.