Clinical research can be broadly divided into two subsets: experimental research and observational research. The vast majority of new medical treatments and technologies are tested through experimental or interventional research, often in the form of randomized trials, before they are adopted into clinical use. In contrast, observational studies are primarily conducted on technologies after they have already been adopted and are being implemented in some sector of the healthcare community. Observational research occupies a critical niche within healthcare research that is complementary to experimental studies. Understanding the relative strengths, weaknesses, similarities, and differences between observational and experimental research is critical to accurately interpreting clinical research.
A Working Definition of Observational Research
Observational research is a research in which the investigator cannot control the assignment of treatment to subjects because the participants or conditions are not being directly assigned by the researcher. Observational research examines predetermined treatments, interventions, and policies and their effects. In practical terms, observational comparative effectiveness research (CER) is typically conducted within one of two settings, either within registries or as subgroup analyses within randomized clinical trials. Registries are generally created with a specific disease, treatment, or population of interest, and can occur within a specific institution, network of institutions, or geographic region within which clinically relevant outcomes are recorded. Subgroup analyses within clinical trials include any subset for which patients are not randomly assigned. Because subgroups are not randomly assigned, subgroup analyses share all the strengths and weaknesses of conventional observational studies, such as confounding and multiple hypotheses testing, and provide a similar level of evidence.
In contrast to observational research, researchers in experimental studies directly manipulate or assign participants to different interventions or environments. A third type of research involves descriptive studies, which are conducted without a treatment and are neither experimental nor observational (1). This type of research is used in the initial exploration and characterization of a healthcare issue. Descriptive studies play no direct role in CER, whereas experimental and observational studies are important in both developmental and CER.
Strengths and Weaknesses of Observational Research Within Comparative Effectiveness Research
Recent focus on the importance of CER was reinvigorated with passage of the Patient Protection and Affordable Care Act (PPACA) in 2010 (2). From a practical research standpoint, this emphasis on CER makes it important to define and understand observational research within the context of CER.
The Agency for Healthcare Research and Quality (AHRQ), the lead federal agency responsible for improving healthcare quality in the United States, defines CER as research that provides “evidence on the effectiveness, benefits, and harms of different treatment options” (3). This evidence is generated via comparative studies of drugs, medical devices, tests, surgeries, or ways to deliver health care. We find such evidence in one of two ways: through experimental studies or through observational studies. Each of these approaches ...