A review of uses of health care utilization databases for epidemiologic research on therapeutics.
OBJECTIVE
Large health care utilization databases are frequently used in variety of settings to study the use and outcomes of therapeutics. Their size allows the study of infrequent events, their representativeness of routine clinical care makes it possible to study real-world effectiveness and utilization patterns, and their availability at relatively low cost without long delays makes them accessible to many researchers. However, concerns about database studies include data validity, lack of detailed clinical information, and a limited ability to control confounding.


METHODS
We consider the strengths, limitations, and appropriate applications of health care utilization databases in epidemiology and health services research, with particular reference to the study of medications.


CONCLUSIONS
Progress has been made on many methodologic issues related to the use of health care utilization databases in recent years, but important areas persist and merit scrutiny.
Schneeweiss
Sebastian
S
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street (suite 3030), Boston, MA 02120, USA. schneeweiss@post.harvard.edu
Avorn
Jerry
J
D015982:Bias; D003219:Confidentiality; D016208:Databases, Factual; D004363:Drug Utilization; D064420:Drug-Related Side Effects and Adverse Reactions; D015340:Epidemiologic Research Design; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008499:Medical Records; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012308:Risk Management; D016896:Treatment Outcome