Coming to Grips with Large Databases

“Measuring Quality, Outcomes, and Cost of Care Using Large Databases,” the supplement that accompanies this issue, may strike some readers as an odd companion to the journal. Why should typical Annals readers, internists devoted mainly to patient care, concern themselves with large health care databases? Colossal electronic files of claims and codes are the habiliments of health services researchers and health care administrators, not clinicians. Clinical internists learn from small sets of meticulously collected primary research and clinical data, not from secondary data collected for billing and other administrative functions. This, however, like much else in health care these days, is changing, like it or not.

As we march through the information age, we increasingly see research that draws information from administrative data sets. We are also witnessing an explosion of clinical guidelines supported by administrative data. With growing frequency, those to whom we must be accountable gauge our professional performance with measures culled from administrative data. In addition, we will probably add to and interact with such databases every day during the course of routine patient care. After all, whenever we check off codes on encounter forms or enter data into electronic medical records, we are helping to create a large database. Thus, the proceedings of the sixth Regenstrief Conference are definitely relevant to Annals clinician-readers.

Work drawn from large databases now often appears in clinical journals, such as The Lancet, JAMA, and The New …