The Center for Outcomes Research and Evaluation (CORE) serves several functions. We perform original, grant funded health services and outcomes research and randomized trials, assist in evaluation activities throughout Maine Medical Center and MaineHealth and conduct independent evaluations through grants and contracts, assist in the medical education programs, and provide research design and statistical consultation throughout the institution. Our principal investigators represent the specialties of internal medicine, trauma surgery, nursing, family medicine, and pulmonology/critical care medicine and we work closely with principal investigators from pediatrics and nephrology. Support staff include a quantatively trained epidemiologist, a population geneticist with a strong statistical background, four master's prepared data analysts including an evaluation specialist, and a research assistant. Specific aspects of the program are described below.

Original Research
The Center excels in the utilization of administrative data to answer research questions. An excellent collaborative relationship with the Center for Evaluative Clinical Sciences (CECS) at Dartmouth Medical School provides access to a comprehensive library of Medicare claims data. Major areas of concentration using Medicare claims data include geographic variation in the delivery and quality of health care; the relationship between diagnostic testing and treatment; the relationship between health care system factors, the delivery of health care, and health outcomes; the relationship between surgical volume and mortality; the relationship between intensity of utilization and outcomes of care; a description of injury in the elderly, including geographic variation and outcomes; and, a study of racial disparities in surgical mortality rates.

Additional original research includes practice-based intervention trials of depression care and tobacco treatment; a study of end of life care at Maine Medical Center; several studies of pain management strategies; a study of the management of fatigue in cancer patients; a study to link multiple sources of information about injuries in the state of Maine; and, surveillance of violent deaths in the state.

Program Evaluation and Quality Improvement
The Center provides program evaluation expertise and services to Maine Medical Center and MaineHealth, as well as independent evaluation funded through state and federal agencies and national organizations. We are currently involved in a comprehensive review of all MaineHealth community programs in an effort to evaluate their effectiveness. CORE is evaluating all care delivered within the MaineHealth system, including hospital, long term, psychiatric, and home health care. This study will result in a report from MaineHealth of quality indicators compared with appropriate benchmarks. In addition, the Center is contracted to perform the evaluation for the Partnership for Tobacco Free Maine's Treatment Initiative.

In addition to the contribution of our program evaluation activities to quality improvement, we also participate in direct and supportive quality improvement activities throughout the institution. Nursing quality improvement projects include an intervention to reduce head molding in premature infants; interventions to prevent pressure ulcers and phlebitis; and an investigation of best lead placement to detect silent ischemia. CORE provides methodologic and statistical support to the Center for Performance Improvement (CPI) when requested. One of CPI's newest physician staff members did a fellowship in clinical evaluative sciences and performed his research project at CORE.

Medical and Nursing Education
CORE is involved in the medical education programs of several departments, with particular emphasis on teaching critical appraisal of the medical literature. This task is most usually performed by one-on-one instruction and participation in MMC departmental "journal clubs". In addition, CORE staff are available to students, residents, and fellows participating in research projects and scholarly activity, through help with design, implementation and analysis. The intent is not to have CORE perform the work but rather to help trainees understand and conduct the research effort with appropriate support.

The nurse researcher works with undergraduate and graduate nursing students as well as residents on research projects as well as lecturing at the nursing schools in the area. She also facilitates literature review and synthesis teams in encouragement of evidence based nursing practice.

Research Design and Statistical Consultation
CORE support staff provides consultation services to clinical and bench researchers on an ad hoc basis. This research support can take many forms, including answering a simple question about which statistical test to use, helping design data collection forms, evaluating the adequacy of an intended study design, and writing the methods section of a grant application. Although our primary role is support, we also occasionally perform data analysis, especially in cases in which the analysis technique requires sophisticated statistical software. We also assist students, nurses, residents, and attendings in the preparation of abstracts, presentations, and papers as well as grant applications.