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Improving the use of clinical databaseshttp://bmj.com/cgi/content/full/324/7347/1194
Information in practiceInfopoints Improving the use of clinical databasesThe need for high quality clinical databases has been thoroughly documented.1-3 They offer the opportunity to carry out evaluative research and clinical audit, inform the planning and management of services, and provide individual clinicians with accurate estimates of the outcome of care that can be shared with prospective patients. Despite these potential benefits, clinical databases have generally had few supporters and have attracted considerable scepticism and criticism. Much of the doubt about their value arises from a tendency to treat them all alike. As with all forms of information or methods of inquiry, both good and bad examples exist. In an attempt to promote both the quality of clinical databases and their
use, we have created a website where visitors can find out what
databases exist (initially restricted to the United Kingdom) and be
provided with an independent assessment of their scope and quality.
To enable us to achieve the latter, a multidisciplinary group
developed and tested an assessment instrument designed to achieve
three objectives This Directory of Clinical Databases (DoCDat) allows visitors to search for and identify databases that may be suitable for their purpose, whether that be evaluative research, clinical audit, supporting shared decision making models, or strategic planning of services. The website allows searches to be made on the basis of one or more medical conditions, a healthcare intervention, and a geographical area. The information provided on the coverage and accuracy of the identified databases enables an assessment to be made as to their suitability. The need for such a service has recently been recognised by the UK government.4 DoCDat provides only an overview of each clinical database, albeit one based on an independent assessment rather than on the views of the database custodians. To delve deeper it is necessary for a potential user to find out more from the database custodian, whose contact details are provided in the DoCDat entry. While adding more databases is the top priority, it is also essential to update and maintain all the entries. This is done by requesting information of changes from database custodians as they are instituted and by an annual inquiry initiated by DoCDat staff. Enabling greater access and use of existing clinical databases is the
immediate aim of DoCDat, but another aim is to improve their quality.
Our experience suggests that some database custodians have rather
limited knowledge and understanding of the methodological issues
relating to database quality. DoCDat aims to advise, where
appropriate, on how quality can be improved. This can be facilitated
by putting database custodians in contact with one another to enable
practical experiences to be shared. Mary Payne Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT
Footnotes The Directory of Clinical Databases (DoCDat) is available at www.lshtm.ac.uk/docdat
Funding: Establishment of the website has been supported by the Nuffield Trust and the Department of Health. Competing interests: Both authors work on DoCDat and wish to see it succeed.
References
Rapid Responses:Read all Rapid Responses
ALL INFORMATION, DATA, AND
MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS
OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH
YOUR HEALTH CARE PROVIDER.
DISCLAIMER: All information, data, and material contained, presented, or provided here is for general information purposes only and is not to be construed as reflecting the knowledge or opinions of the publisher, and is not to be construed or intended as providing medical or legal advice. The decision whether or not to vaccinate is an important and complex issue and should be made by you, and you alone, in consultation with your health care provider.
Copyright 2012 by Vaccination News, A Non-Profit Corporation. All Rights Reserved. This content may not be copied unless permission in writing from Sandy Gottstein has been obtained. 
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 "A foolish faith in authority is the worst enemy of truth." -- Albert Einstein, letter to a friend, 1901 "I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education." -- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820 "What's the point of vaccination if it doesn't protect you from the unvaccinated?" -- Sandy Gottstein "Who gets to decide what the greater good is and how many will be sacrificed to it?" -- Sandy Gottstein |
to
inform potential users of a database's scope (inclusion criteria,
geographical area and time period covered, and mandatory and optional
variables included), how it can be accessed (contact details of
custodian), and its methodological strengths and weaknesses. All this
information is obtained by a trained interviewer to ensure an
independent assessment is obtained. 