OBSTACLES AND APPROACHES TO CLINICAL DATABASE RESEARCH - EXPERIENCE AT THE UNIVERSITY-OF-CALIFORNIA, SAN-FRANCISCO

With increasing availability of clinical data in machine-readable form , and decreasing cost of storing and manipulating that data, retrospec tive research using clinical databases has become more feasible. Nonet heless, much of the potential for clinical research using these data r emains unrealized. Obstacles to clinical database research include dif ficulty accessing data, difficulty using retrospective data to draw va lid inferences about medical tests and treatments, and a shortage of i nvestigators trained and interested in using a clinical database to an swer their questions. At the University of California, San Francisco, we have developed a Clinical Database Research Program (CDRP) to try t o overcome these obstacles. The CDRP maintains a relational database o f patient data obtained from diverse sources and a small staff dedicat ed to providing such data to researchers. The CDRP staff also provides support for design and analysis of studies using the database-the dev elopment of methods for such studies is our primary research interest. Finally, to increase the number of investigators using the database f or research, we are integrating training in clinical epidemiology and clinical research methods into residency and fellowship training, and offering an elective in clinical database research for trainees who wi sh to undertake a specific project.