Using Databases Effectively: Toward Comparative Effectiveness

1. Using Databases Effectively: Toward Comparative Effectiveness Judith Effken Barbara Brewer Deborah Vincent

2. Workshop Objectives On completion participants will be able to: • Access large databases and data sets that might be useful in their practice or research. • Use an existing large data set to answer their own questions. • Discuss strengths and limitations of large databases. • Describe comparative effectiveness: What it is, why it’s important, how it’s being done, and its implications for practice

3. What’s a Database? • An electronic filing cabinet • A collection of computerized data files (Date, 1995).  • “A collection of data stored in a standardized format, designed to be shared by multiple users" (Post, 1999).  • Examples you know: CINAHL, MEDLINE, PUBMED

4. Why would we want one? • To answer questions related to: • health policy decisions • quality, costs, outcomes of care • marketing • health care system integration • identifying population health needs • finding new markets

5. Advantages • They are compact so they eliminate the need for huge paper files. • They help us quickly access information. • They eliminate the drudgery of maintaining paper files. • Accurate current information is available at all times. • They allow us to better manage data. • They facilitate research.

6. In a flat database, all data stored in a single table. Because everything is in one table, easy to create and maintain.  But redundancy often is an issue. Example: An EXCEL spreadsheet In a relational database, data stored in many tables.  Each table describes a separate entity   Harder to create, but better for complicated problems.  Eliminate the redundancies of flat databases.  Data easier to understand.  Example: An ACCESS database Flat or Relational?

7. Segment of an Excel Spreadsheet

8. Classes Two Tables from an ACCESS Database Linked by a primary key (Class number) Students

10. Results of the Student & Teacher Query

11. Large Data Sets • Typically numerical data • Exist in computer-readable form • Searchable; can query • Can do statistical calculations • So big that their use requires special statistical methods and computer technology • Can be used by researchers who didn't create them (Connell, Diehr & Hart, 1987).

12. Where can I find a large data set? Health Data Tools and Statistics The National Center for Health Statistics(CDC) National Health and Nutrition Survey National Health Interview Survey National Ambulatory Medical Care Survey National Hospital Discharge Survey Census USDHHS (Inventory of pain data) CDC Wonder Statistics from Center for Medicare and Medicaid Services US Census Bureau StatisticsOther sources include insurance claim data, such as the HCFA Medicare Claims Database, MEDSTAT database, Workers' Compensation claims, hospital discharge registries, Arizona health and vital statistics, and local healthcare agencies. Or do a Google search on Health Data Sets or Health Data.

13. Challenge 1. Work in Teams to find large Databases and Data Sets • Find a large database that might answer some practice question. • Find a large data set online. • What format is it in? Flat? Relational? • What kind of data does it house? • What software would you need to use it? • Is it free? • How do the database and data set differ in structure and contents? • Be prepared to share your discoveries.

14. Challenge 2: Use a Large Data Set to Answer Your Own Questions • Working in teams, download the Hospital Discharge Data set at _________ into an Excel spreadsheet on your computer. • Also download the other two files that describe the data set. • What questions might you be able to answer with the data? • Use the data set to answer those questions. • Be prepared to tell us what you found.

15. Challenge 3. Comparative Effectiveness Research - How might it improve care? • Explore AHRQ’s Effective Healthcare Program website and skim or read some of the readings on the Reference List. • What is Comparative Effectiveness Research? • How might it benefit clinicians? Consumers? • How is the research done? • Review the comparative effectiveness of GERD drugs. • What impact might this study have on practice? • How might the results be disseminated?

16. References • Date, C. J. (1995).  An introduction to database systems, 6th ed.  Reading, MA: Addison Wesley. • Post, G. V. (1999).  Database management systems:  Designing and building business applications.  Boston: Irwin McGraw-Hill. • Morris, P. E. & Munro, C. L. (2009). Will comparative effectiveness research increase patient safety in intensive care units? American Journal of Critical Care, 18, 504-6. • Shah, N. D. et al. (2010). Translating comparative effectiveness into practice: The case of Diabetes medications. Medical Care 48(6) S153-8. • AHRQ Releases First Comparative Effectiveness Review Certain Drugs Found as Effective as Surgery for Management of GERD (2005). Available at http://www.ahrq.gov/news/press/pr2005/gerdpr.htm • AHRQ’s Effective Healthcare Program. Available online at http://www.effectivehealthcare.ahrq.gov/index.cfm/what-is-comparative-effectiveness-research1/

17. References • Manchicanti et al. (2010). Facts, fallacies and politics of comparative effectiveness Research: Part 1. Basic considerations. Pain Physician 13, E23-54. • Manchicanti et al. (2010). Facts, fallacies and politics of comparative effectiveness Research: Part 2 – Implications for Interventional Pain Management. Pain Physician 13. R55-79. • Schoeles & Pickler (2010). Comparative effectiveness research and pediatric health care. J. of Pediatric Health Care 24(3), 208-10.