Chronic diseases are the major source of morbidity, mortality, and resource utilization. Large-scale longitudinal databases are rapidly proliferating in both single- and multi-institutional settings, providing clinical data on a broad range of patients who receive ‘real world’ management. Although bias and changing medical management may limit the types of questions that can be addressed using the data contained in longitudinal clinical databases, many initial hypotheses can be generated from the data. Because chronic diseases persist over long periods of time, understanding the impact of temporal relationships, and of concurrent clinical events and contexts is critical to meaningful interpretation of clinical data. Adapting techniques initially developed for the physical sciences and for statistical process control can produce visual displays of clinical data that capture complex temporal and contextual information. With these tools, investigators can quickly explore vast quantities of clinical data, and discover new temporal relationships and emerging trends.

Keywords:
Clinical databases, Chronic diseases, Data visualization
1.
Resources and priorities for chronic disease prevention and control, 1994. Morb Mortal Wkly Rep 1997;46:286–287.
2.
Chronic disease reports: Deaths from nine chronic diseases – United States, 1986. Morb Mortal Wkly Rep 1990;39:19–20.
3.
Kahn MG: The desktop database dilemma. Acad Med 1993;68:34–37.
4.
Fries JF, McShane DJ: ARAMIS (the American Rheumatism Association Medical Information System). A prototypical national chronic-disease data bank. West J Med 1986;145:798–804.
5.
Nolan J, Schioler T, Brosnan P, Irjala K, Nuutila P, McNair P, O’Moore R: Clinical utility of an international thyroid database. Clin Chim Acta 1993;222:117–121.
6.
Reintge D, King J, Cox C: Computer database for melanoma registry. A clinical management and research tool to monitor outcomes and ensure continuous quality improvement. Surg Clin North Am 1996;76:1273–1285.
7.
Price DA, Wilton P, Jonsson P, Albertsson-Wikland K, Chatelain P, Cutfield W, Ranke MB: Efficacy and safety of growth hormone treatment in children with prior craniopharyngioma: An analysis of the Pharmacia and Upjohn International Growth Database (KIGS) from 1988 to 1996. Horm Res 1998;49:91–97.
8.
Grover FL, Shroyer LW, Edwards FH, Pae WE, Jr, Ferguson TB, Jr, Gay WA, Jr, Clark RE: Data quality review program: The Society of Thoracic Surgeons adult cardiac national database. Ann Thorac Surg 1996;62:1229–1231.
9.
Tierney WM, McDonald CJ: Practice databases and their uses in clinical research. Stat Med 1991;10:541–557.
10.
McDonald CJ, Hui SL: The analysis of humongous databases: Problems and promises. Stat Med 1991;10:511–518.
11.
Hlatky MA: Using databases to evaluate therapy. Stat Med 1991;10:647–652.
12.
Lee JY: Uses of clinical databases. Am J Med Sci 1994;308:58–62.
13.
Moses LE: Innovative methodologies for research using databases. Stat Med 1991;10:629–633.
14.
Pryor DB, Lee KL: Methods for the analysis and assessment of clinical databases: The clinician’s perspective. Stat Med 1991;10:617–628.
15.
Psaty BM, Koepsell TD, Siscovick D, Wahl P, Logerfo JP, Inui TS: An approach to several problems in using large databases for population-based case-control studies of the therapeutic efficacy and safety of anti-hypertensive medicines. Stat Med 1991;10:653–662.
16.
Byar DP: Problems with using observational databases to compare treatments. Stat Med 1991;10:663–666.
17.
Moses LE: Measuring effects without randomized trials? Options, problems, challenges. Med Care 1995;33(Suppl 4):AS8–AS14.
18.
Byar DP: Why databases should not replace randomized clinical trials. Biometrics 1980;36:337–342.
19.
D’Agostino RB, Kwan H: Measuring effectiveness: What to expect without a randomized control group. Med Care 1995;33(Suppl 4):AS95–AS105.
20.
Van der Linden S, Goldsmith CH, Woodcock J, Nassonova V: Can observational studies replace or complement experiment? J Rheumatol 1994;21(Suppl 41):57–61.
21.
Sacristan JA, Soto J, Galende I, Hylan TR: A review of methodologies for assessing drug effectiveness and a new proposal: Randomized database studies. Clin Therap 1997;19:1510–1517.
22.
Sacristan JA, Soto J, Galende I, Hylan TR: Randomized database studies: A new method to assess drugs’ effectiveness? J Clin Epidemiol 1998;51:713–715.
23.
Sacristan JA, Soto J, Galende I: Large-database research: Complement to randomized trials? [letter]. Ann Int Med 1998;128:875.
24.
Wiederhold G, Fries JF, Weyl S: Structured organization of clinical databases; in Meier DA, Miller SW (eds): AFIPS Conference Proceedings, 1975. New Jersey, AFIPS Press, 1975, pp 479–485.
25.
Kahn MG, Marrs KA: Creating temporal abstractions in three clinical information systems. Proc Annu Symp Comput Appl Med Care 1995:392–396.
26.
Kahn MG: Modeling time in medical decision-support programs. Med Decis Making 1991;11:249–264.
27.
Snodgrass R, Ahn I: Temporal databases. IEEE Computer 1986;19:35–42.
28.
Etzion O, Jajodia S, Sripada S: Temporal databases: Research and practice. Berlin, Springer-Verlag, 1998.
29.
Das AK, Tu SW, Purcell GP, Musen MA: An extended SQL for temporal data management in clinical decision-support systems; in Frisse ME (ed): Proceedings of the Annual Symposium on Computer Applications in Medical Care. New York, 1992, pp 128–132.
30.
Kahn MG, Fagan LM, Tu S: Extensions to the time-oriented database model to support temporal reasoning in medical expert systems. Methods Inf Med 1991;30:4–14.
31.
Nielson GM, Hagen H, Muller H: Scientific visualization: Overviews, methodologies, and techniques. Los Alamitos, CA, IEEE Computer Society Press, 1997.
32.
Patrikalakis NM: Scientific visualization of physical phenomena. New York, Springer- Verlag, 1991.
33.
Cole WG: Understanding Bayesian reasoning via graphical displays; in Bice K, Lewis C (eds): Human Factors in Computing Systems: CHI ’89;1989. Austin, TX, ACM Press, 1989.
34.
Elting LS, Bodey GP: Is a picture worth a thousand medical words? A randomized trial of reporting formats for medical research data. Methods Inf Med 1991;30:145–150.
35.
Cole WG, Stewart JG: Metaphor graphics to support integrated decision making with respiratory data. Int J Clin Monit Comput 1993;10:91–100.
36.
Robertson GG, Card SK, Mackinlay JD: Information visualization using 3-D interactive animation. Comm ACM 1993;36:57–71.
37.
McMullin ST, Reichley RM, Kahn MG, Dunagan WC, Bailey TC: Automated system for identifying potential dosage problems at a large university hospital. Am J Health Syst Pharm 1997;54:545–549.
38.
Grant EL, Leavenworth RS: Statistical quality control, ed 7. New York, McGraw-Hill, 1996.
39.
Kahn MG, Bailey TC, Steib SA, Fraser VJ, Dunagan WC: Statistical process control methods for expert system performance monitoring. J Am Med Inform Assoc 1996;3:258–269.
1999
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