NBER Center of Excellence

Overview

The National Bureau of Economic Research (NBER) and a team of collaborators have established a Center of Excellence to identify associations between clinical and economic outcomes and health system characteristics, as well as the effects of system organization on outcomes. The goal is to learn which delivery system features influence the diffusion of evidence-based care, to enhance the quality and value of health systems.

The aims of the NBER Center of Excellence are to:

1. Characterize the current delivery system and track changes in delivery system structure across space and over time.
2. Gather data on the use of evidence from patient-centered outcomes research (PCOR) and related clinical and economic outcomes and merge those data with delivery system information.
3. Use these data sources to examine associations between differences in delivery system structure and use of PCOR-based evidence and related clinical and economic outcomes.

The NBER Center of Excellence will examine performance of different types of health systems in various geographic locations over time. It also will explore the use of evidence- and non-evidence-based care to treat patients, such as oncology and pediatric patients who need customized care. Finally, the NBER Center will analyze outcomes of corporate consolidation.

NBER has teamed with many partners to study health systems across the country. One partner, the Health Research & Educational Trust (HRET), is the nonprofit research and education affiliate of the American Hospital Association (AHA). For the NBER Center of Excellence projects, HRET oversees the use of AHA data and other data to provide information on hospitals and the systems they are embedded in.

A second partner, the Network for Regional Healthcare Improvement (NRHI), is a national organization that represents more than 35 regional health improvement collaboratives. NRHI is coordinating and assisting four States in developing the all-payer claims data for this work and is conducting analyses using those data for two NBER Center of Excellence projects.

Research Projects

The NBER Center of Excellence is conducting five research projects for the initiative, described below. Two of the projects take a broad look at how health system characteristics are related to the use of PCOR-based evidence and related clinical and economic outcomes. Two other projects look at care for cancer patients and care for children who require specialized delivery systems. The fifth project examines the causes and consequences of growing corporate consolidation in two understudied health care industries that account for a significant share of total medical spending—post-acute care facilities and dialysis facilities.

• Delivery System Structure and Outcomes: A National Look is examining how the structure of health systems across the nation is related to the use of PCOR-based evidence and to clinical and economic outcomes. It is also investigating how changes in health systems influence the use of PCOR-based evidence. The study will examine system features at the organization and market levels.
• Delivery System and Outcomes in Four States focuses on the structure and outcomes of health systems in Colorado, Massachusetts, Oregon, and Utah. These States have very different health systems and good sources of data that will allow the project to compare care delivery across settings and track the use of PCOR-based evidence and clinical and economic outcomes as health systems in these States change over time.
• Characteristics of High-Performing Delivery Systems of Cancer Care is examining how the structure of a health system for oncology relates to the use of PCOR-based evidence and outcomes for cancer patients. This will include describing characteristics of cancer care systems; evaluating variations in these system characteristics and capabilities; and examining the influence of these characteristics on PCOR-based care, outcomes, and costs.
• Accelerating the Performance of Pediatric Health Systems is studying health systems for children and how these systems relate to delivery of PCOR-based evidence and clinical and economic outcomes. The project will characterize pediatric health systems and track changes in various locations over time; quantify the quality, costs, and value of pediatric health care provided in inpatient and outpatient settings; and identify the characteristics of pediatric health systems that deliver PCOR-based care and achieve desired outcomes.
• Causes and Consequences of Institutional Consolidation is analyzing the causes and consequences of changes in the corporate structure of post-acute care facilities and dialysis centers. The project will document consolidation and organizational change in these two areas and will examine their impact on the use of PCOR-based evidence, spending, and clinical outcomes.

Data Core

Each Center of Excellence is developing a data core that consists of the data, tools, and methodologies needed to conduct sophisticated, innovative analyses of health systems. The NBER Center of Excellence is collecting the following three types of data to support its research projects:

1. An "enhanced system database." This is a collection of data that can be used to describe health systems at both the organizational and market level. Providers included in the database are acute care hospitals, physician organizations, and other providers of care, such as post-acute care units and dialysis facilities.
2. Administrative data that can be used to measure the use of PCOR-based evidence, related clinical outcomes, and cost of care. It will include Medicare and Medicaid data, national commercial insurance data, cancer registry data, dialysis facility and cost reports, and the Healthcare Cost and Utilization Project’s Kids’ Inpatient Database. In addition, collaborators from the Center for Improving Value in Health Care, HealthInsight, Massachusetts Health Quality Partners, and Oregon Health Care Quality Corporation will use all-payer claims databases for four States.
3. Patient and family self-reports about the quality of care received. These data include the Consumer Assessment of Healthcare Providers and Systems, Hospital Consumer Assessment of Healthcare Providers and Systems, and other sources for family surveys.

The data core will also include data from the American Hospital Association survey, Irving Levin data on mergers, Online Survey Certification and Reporting/Certification and Survey Provider Enhanced Reporting data, and the Health Resources and Services Administration’s Area Resource File, which contains information on health resources in each of the Nation’s counties.

The research from the NBER Center of Excellence will focus on both the national and State levels. The analyses will measure health system organization at a point in time, as well as track changes over time and across geographic areas. In addition to an overarching analysis of health system characteristics and their relationship to the use of evidence and clinical and economic performance, the NBER Center of Excellence will examine data on patients with cancer, children, and patients receiving treatment in post-acute care facilities or dialysis centers.