High-quality clinical databases: breaking down barriers

Abstract

The need for accurate systematic information to inform not only clinical practice and health-services management but also evaluation research and clinical audit is now well recognised. Less well recognised are the benefits that could result if the proponents of each of these activities combined their resources to obtain the data they need. Irrespective of the uses to which they wish to put the data, clinicians, managers, consumers, and researchers all need data, from consecutive cases, that are complete and accurate, that are based on standard definitions of clinical disorders, interventions, and outcomes, and that include information on those characteristics of patients that affect outcome. Anyone familiar with administrative data collected routinely in most health systems will recognise the inadequacy of information from such sources. In response to such failings, groups of clinicians in many countries have established their own high-quality clinical databases (HQCDs). 1 Pryor DB Califf RM Harrell FE et al. Clinical data bases: accomplishments and unrealized potential. Med Care. 1985; 23: 623-647 Crossref PubMed Scopus (73) Google Scholar Until recently, most schemes have been regional rather than national—in the USA, cardiac surgery in New York State; 2 Hannan EL Kilburn HJr O'Donnell JF Lukacik G Shields EP Adult open heart surgery in New York State: an analysis of risk factors and hospital mortality rates. JAMA. 1990; 264: 2768-2774 Crossref PubMed Scopus (481) Google Scholar in the UK, surgery in Lothian in the 1970s, 3 Gruer R Gordon DS Gunn AA Ruckley CV Audit of surgical audit. Lancet. 1986; i: 23-26 Summary Scopus (67) Google Scholar followed by obstetrics in the North West Thames region, orthopaedics in the Trent and North West region, and haematology in the Northern region in the 1980s. 4 Charlton BG Taylor PRA Proctor SJ The PACE (population-adjusted clinical epidemiology) strategy: a new approach to multi-centred clinical research. Q J Med. 1997; 90: 147-150 Crossref Scopus (42) Google Scholar The most advanced and ambitious work in this area in the UK has been in intensive care. 5 Rowan KM Intensive Care National Audit and Research Centre— past, present and future. Care Critically III. 1994; 10: 148-149 Google Scholar Despite recognition of the potential value of such databases for audit, there is less awareness of how they can be used to aid clinical practice, manage services, and evaluate health technologies.