by Jonathan B. Perlin and Joel Kupersmith
ABSTRACT:
In medical practice, an "inferential gap" exists in two contexts: the nonapplication of relevant existing evidence, and the absence of evidence germane to a particular clinical situation. Randomized controlled trials are the current gold standard of evidence development; however, they suffer limits of generalization to the "real world." Conversely, observational studies might be more generalizable but are prone to bias, data inconsistency, and measurement error. The electronic health record offers hope for supporting the real-time presentation of information relevant to a clinical situation and serves as a platform for the conduct of large observational studies and novel quasi-experimental research. [
Health Affairs 26, no. 2 (2007): w192-w194 (published online 26 January 2007; 10.1377/hlthaff.26.2.w192)]
In this age of science it is perhaps surprising how often clinical decisions are made absent the application of existing knowledge and how often clinical judgment or intuition is required when no knowledge exists. Walter Stewart and colleagues examine an "inferential gap" that exists in two contexts: the nonapplication of relevant existing evidence and the absence of evidence germane to a particular clinical situation. 1