Developing high quality clinical databases

Although it is almost 20 years since Arnold Relman heralded the dawning of the “era of assessment and accountability,”1 we still cling largely to a traditional research paradigm based on ad hoc studies. We do this despite well recognised limitations: such studies are expensive, and so only a limited range of interventions have been, and can ever be, investigated; the rapidity with which health technologies evolve means study results may be of no practical value by the time they are obtained; the results are often of uncertain generalisability as they tend to be carried out in atypical settings; the participating clinicians often have little sense of ownership; and small samples restrict the scope for subgroup analyses and thus the practical value of the results. High quality clinical databases offer an alternative approach, with the potential to bring research closer to practice and audit. The advantages include wide ownership and high generalisability through the …