Comparative Effectiveness Research & Sources Of Data

Question 1

What is Comparative Effectiveness Research?

Answer 1

An evalutation of the impact of different treatments for a disease or a particular population of patients. May compare similar drugs (ie. competing drugs within same class), or analyze different approaches (ie. surgery vs drug therapy)

Question 2

What is the difference between drug efficacy and effectiveness?

Answer 2

Drug efficacy = if a drug has the ability to produce an intended/desired effect

Drug effectiveness = whether a drug achieves the desired in the REAL WORLD (not just in controlled environment)

Question 3

What data can we use for non-experimental studies (aka studies we don’t conduct ourselves)?

Answer 3

Cohort studies
Disease/Drug registries
Public survey data
Health maintenance organizations
Clinical databases
Insurance databases
Govt databases
Public medical records databases
In-hospital databases

Question 4

What are some desired qualities of a database? (6)

Answer 4

Representative of the population
Large
Up to date
Continuity
Linkages with identifiers
Rapid accessibility

Question 5

How do HMOs provide BETTER databases of information for non-experimental studies?

Answer 5

Since HMOs contain healthcare provision, billing, operations and patient demographics all in one network, it is easier to identify and follow up with subjects.
The populations are large, diverse and defined!

Question 6

What are some WEAKNESSES of HMO databases when collecting information for non-experimental studies?

Answer 6

• Absence of populations that are UNINSURED
• Limits on race/ethnicity/socioeconomic status
• Smaller fraction of elderly compared to the general population
• Does not account for prescription medications filled out of plan/OTCs/inpatient drug dispensing

Question 7

What TWO programs are included in government databases related to health? What populations do they capture?

Answer 7

1. Medicaid - low income, chronically disabled
2. Medicare - all US residents ≥65 yo, permanently disabled adults UNDER 65 yo

Question 8

What are some strengths of government health databases?

Answer 8

Large size
Very accurate claims
More representation of underserved populations
Can validate outcome
Link to external data

Question 9

What are some weaknesses of government health databases?

Answer 9

Non-representative of full population
Some information not publicly available/limited accessibility
Limitations on Rx coverage
Some subjects not eligible
Out-of-plan care not captured

Question 10

What is the PHIS database?

Answer 10

A comparative pediatric database containing clinical and financial data elements

Question 11

What is the Premier database?

Answer 11

A consortium of US not-for-profit hospitals and health systems, lots of complete profiles and large volume of discharge information.

Question 12

What are some strengths of in-hospital databases? (5)

Answer 12

• sample size
• versatile data source
• good data quality
• efficient
• good data longevity

Question 13

What are some weaknesses of in-hospital databases? (3)

Answer 13

• generalizability of study findings is questionable (lots of special cases + demographics)
• Possible misclassifications of: disease, exposure, outcome status
• Ascertainment bias (variable stay length)