Developing high quality clinical databasesBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7105.381 (Published 16 August 1997) Cite this as: BMJ 1997;315:381
The key to a new research paradigm
- Nick Black, Professor of health services researcha
- a Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT
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 …