Twelve years ago, Ellwood1 described
"a technology of experience" by which observational databases would be used
to learn about how best to improve implementation of medical interventions.
Ellwood envisioned a unified national database containing information on all
facets of patient care. Researchers and decision makers would have the ability
to analyze relevant data to answer questions of interest. Although a single
national database of this kind has not been realized, a number of very large
registries have been successfully assembled and used to learn about important
associations between treatments and outcomes.2
In this issue of THE JOURNAL, Cannon et al3
report on the relation between speed of performing primary angioplasty and
in-hospital mortality among patients with acute myocardial infarction. Taking
advantage of a multicenter database containing information about more than
750,000 patients, the authors focused on 27,080 patients who presented with
ST-segment elevation or left bundle-branch block and who were treated with
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