The other side of clinical trial monitoring; assuring data quality and procedural adherence
Abstract
BackgroundData monitoring can mean different things. It can mean statistical methodologies for clinical trial monitoring, interim data analysis, monitoring for quality control or assurance or safety reporting to regulatory agencies. PurposeThe various facets of data monitoring will be discussed and reviewed from primarily an industry perspective. MethodsBy careful attention to the design and conduct of a clinical trial, the expense of monitoring can be markedly reduced. Careful attention should be given to the qualifications of investigators in the selection of clinical sites and central facilities. Site personnel must be adequately trained. The sponsor should utilize appropriately qualified individuals to supervise the overall conduct of the trial. The monitor should visit the investigator at the site of the investigation frequently enough to ensure acceptable quality. The monitor is responsible for inspecting the case report forms at regular intervals. Quality control should be applied to each stage of data handling to ensure that all data are reliable and have been processed correctly. The auditor will assess whether the site is being monitored in accordance with the monitoring plan. The determination of the extent and nature of monitoring should be based on considerations such as the objective, design and complexity of the trial. Statistical sampling may be an acceptable method for selecting the data to be verified. The monitor should ensure that adverse events are reported. Study data will be monitored on an ongoing basis to ensure patient safety. The sponsor may utilize a Data Monitoring Committee to protect the validity of a trial. ConclusionsDiscussions between industry, academia and regulatory groups regarding the optimal extent and methods for monitoring of clinical trials are encouraged.
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Standard processes are often implemented by local study staff to enhance data quality and reduce bias by detecting and reducing missing or incomplete data, inaccuracies, and excessive variability in measurements.
“Standard processes are often implemented by local study staff to enhance data quality and reduce bias by detecting and reducing the amount of missing or incomplete data, inaccuracies, and excessive variability in measurements.390”
From SPIRIT 2025 explanation and elaboration: updated guideline for protocols of randomised trials (2025) · cites this paper as [390]
Cites
Peto, R., & Baigent, C. (1998) · BMJ · doi:10.1136/bmj.317.7167.1170 · Cited by 245 · see citing works
Reducing the costs of phase III cardiovascular clinical trials
Eisenstein, E. L., Lemons, P. W., Tardiff, B. E., Schulman, K. A., Jolly, M., & Califf, R. M. (2005) · American Heart Journal · doi:10.1016/j.ahj.2004.04.049 · Cited by 139 · see citing works
Guidelines for Quality Assurance in Multicenter Trials
Knatterud, G. L., Rockhold, F. W., George, S. L., Barton, F. B., DAVIS, C. E., Fairweather, W. R., Honohan, T., Mowery, R. P., & O’Neill, R. T. (1998) · Controlled Clinical Trials · doi:10.1016/s0197-2456(98)00033-6 · Cited by 113 · see citing works
Policy developments in regulatory approval
Temple, R. (2002) · Statistics in Medicine · doi:10.1002/sim.1298 · Cited by 54 · see citing works
Paradigm shifts in clinical trials enabled by information technology
Marks, R. G., Conlon, M., & Ruberg, S. J. (2001) · Statistics in Medicine · doi:10.1002/sim.736 · Cited by 50 · see citing works
(1999) · Wiley eBooks · doi:10.1002/0470846364 · Cited by 48 · see citing works
Developing systems for cost-effective auditing of clinical trials
Califf, R. M., Karnash, S. L., & Woodlief, L. H. (1997) · Controlled Clinical Trials · doi:10.1016/s0197-2456(96)00237-1 · Cited by 35 · see citing works
Regulatory perspectives on data monitoring
O’Neill, R. T. (2002) · Statistics in Medicine · doi:10.1002/sim.1287 · Cited by 32 · see citing works
The European regulatory experience
Lewis, J. A. (2002) · Statistics in Medicine · doi:10.1002/sim.1297 · Cited by 19 · see citing works
A Review of the Source Document Verification Process in Clinical Trials
Schuyl, M. L., & Engel, T. (1999) · Drug Information Journal · doi:10.1177/009286159903300319 · Cited by 16 · see citing works
Data Management And Quality Assurance
Fong, D. (2001) · Drug Information Journal · doi:10.1177/009286150103500321 · Cited by 12 · see citing works
Guideline for the Monitoring of Clinical Investigations
Rosenbaum, D., & Smith, F. (1998) · CRC Press eBooks · doi:10.1201/9781439805909-23 · Cited by 5 · see citing works
Systematic Measures for the Prevention and Early Detection of Investigator Fraud
Walsh, R. (1994) · Drug Information Journal · doi:10.1177/009286159402800441 · Cited by 2 · see citing works
Madison, T., & Plaunt, M. R. (2010) · Informa Healthcare eBooks · doi:10.3109/9781439822463.041 · Cited by 2 · see citing works
A Review of the Source Document Verification Process in Clinical Trials
Schuyl, M. L., & Engel, T. (1995) · Drug Information Journal · doi:10.1177/009286159502900431 · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials
Chan, A.-W., Tetzlaff, J. M., Gotzsche, P. C., Altman, D. G., Mann, H., Berlin, J. A., Dickersin, K., Hrobjartsson, A., Schulz, K. F., Parulekar, W. R., et al. (2013) · BMJ · doi:10.1136/bmj.e7586 · Cited by 6,251 · see citing works
SPIRIT 2025 explanation and elaboration: updated guideline for protocols of randomised trials
Hróbjartsson, A., Boutron, I., Hopewell, S., Moher, D., Schulz, K. F., Collins, G. S., Tunn, R., Aggarwal, R., Berkwits, M., Berlin, J. A., et al. (2025) · BMJ · doi:10.1136/bmj-2024-081660 · Cited by 171 · see citing works
Bakobaki, J. M., Rauchenberger, M., Joffe, N., McCormack, S., Stenning, S. P., & Meredith, S. K. (2011) · Clinical Trials · doi:10.1177/1740774511427325 · Cited by 85 · see citing works
A systematic review of on-site monitoring methods for health-care randomised controlled trials
Macefield, R. C., Beswick, A. D., Blazeby, J. M., & Lane, J. A. (2013) · Clinical Trials · doi:10.1177/1740774512467405 · Cited by 42 · see citing works
“Two articles related to the pharmaceutical industry [6,45].”
BackgroundMitchel, J. T., Kim, Y. J., Choi, J., Park, G., Cappi, S., Horn, D., Kist, M., & D’agostino, R. B. (2011) · Drug Information Journal · doi:10.1177/009286151104500404 · Cited by 48 · see citing works
Remote Source Document Verification in Two National Clinical Trials Networks: A Pilot Study
Mealer, M. L., Kittelson, J. K., Thompson, B., Wheeler, A. P., Magee, J. C., Sokol, R. J., Moss, M. M., & Kahn, M. G. (2013) · PLoS ONE · doi:10.1371/journal.pone.0081890 · Cited by 31 · see citing works
“Currently, oversight requires a study monitor to travel to the clinical site[7] to perform a number of tasks designed to ensure the validity and integrity of the clinical trial results regardless of the intervention being tested [8,9] (Table 1).”
BackgroundRegistry-Based Randomized Controlled Trials: A New Paradigm for Surgical Research
Zolin, S. J., Petro, C. C., Prabhu, A. S., Fafaj, A., Thomas, J. D., Horne, C. M., Tastaldi, L. G., Alkhatib, H., Krpata, D. M., Rosenblatt, S. M., et al. (2020) · Journal of Surgical Research · doi:10.1016/j.jss.2020.05.069 · Cited by 28 · see citing works
Building Quality in Clinical Trials With Use of a Quality Systems Approach
Kleppinger, C., & Ball, L. K. (2010) · Clinical Infectious Diseases · doi:10.1086/653058 · Cited by 27 · see citing works
Biermann, M. (2014) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2014.01.007 · Cited by 17 · see citing works
A systematic search for reports of site monitoring technique comparisons in clinical trials
Bakobaki, J. M., Joffe, N., Burdett, S., Tierney, J. F., Meredith, S. K., & Stenning, S. P. (2012) · Clinical Trials · doi:10.1177/1740774512458993 · Cited by 16 · see citing works
Stanley, R. M., Lillis, K. A., Zuspan, S. J., Lichenstein, R., Ruddy, R. M., Gerardi, M. J., & Dean, J. M. (2010) · Contemporary Clinical Trials · doi:10.1016/j.cct.2010.05.007 · Cited by 16 · see citing works
“…b Department of Pediatrics, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo NY, United States c Department of Pediatrics, University of Utah, Salt Lake City, UT, United States d Department of Pediatrics, University of Maryland, MD, United States e…”
BackgroundA Data-Driven Approach to Risk-Based Source Data Verification
Nielsen, E., Hyder, D., & Deng, C. (2013) · Therapeutic Innovation & Regulatory Science · doi:10.1177/2168479013496245 · Cited by 16 · see citing works
“ingly focused on risk-based monitoring; however, many of these discussions to date have been theoretical rather than data driven.(3-19) Therefore, this study used historical data and simulation methodology to explore the risks (unidentified problems) and benefits (cost reductions) associated with specified reduced SDV…”
MethodCentral data monitoring in the multicentre randomised SafeBoosC-III trial – a pragmatic approach
Olsen, M. H., Hansen, M. L., Safi, S., Jakobsen, J. C., Greisen, G. O., Gluud, C. N., The SafeBoosC-III Trial Group, Pellicer, A., Bargiel, A., Hopper, A. O., et al. (2021) · BMC Medical Research Methodology · doi:10.1186/s12874-021-01344-4 · Cited by 14 · see citing works
Data Collection and Quality Control
Friedman, L. M., Furberg, C. D., DeMets, D. L., Reboussin, D. M., & Granger, C. B. (2015) · Springer eBooks · doi:10.1007/978-3-319-18539-2_11 · Cited by 15 · see citing works
Accelerating Life Sciences Research with Blockchain
Charles, W. (2020) · Studies in big data · doi:10.1007/978-981-15-9547-9_9 · Cited by 14 · see citing works
Occupational burnout among clinical research associates in China
Fu, Z., Yuan, Y., & Jiang, M. (2021) · Occupational Medicine · doi:10.1093/occmed/kqab111 · Cited by 11 · see citing works
Gillespie, B. W., Laurin, L., Zinsser, D., Lafayette, R. A., Marasà, M., Wenderfer, S. E., Vento, S., Poulton, C. J., Barisoni, L. M. C., Zee, J., et al. (2021) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2021.100749 · Cited by 9 · see citing works
The pharmacists’ role in clinical research
Gamboa, M. M. L., Brunetto, A. T., dos Santos, M. E. F., & Gregianin, L. J. (2011) · Farmacia Hospitalaria · doi:10.1016/j.farma.2010.10.006 · Cited by 7 · see citing works
An Institutional Review Board-Based Clinical Research Quality Assurance Program
Lad, P. M., & Dahl, R. (2013) · Accountability in Research · doi:10.1080/08989621.2013.749743 · Cited by 5 · see citing works
“Auditing and monitoring processes are central to the development of a QMS (Arbit and Paller, 2006; Berro et al., 2011; Williams, 2006; Shamoo, 1991a,b).”
BackgroundCross-sectional Study on Occupational Stress of Clinical Research Associates in China
Ruan, J. (2014) · Journal of Clinical Trials · doi:10.4172/2167-0870.1000167 · Cited by 4 · see citing works
“The CRAs or monitors are roles to ensure that the clinical trial is conducted and documented properly, acting as the contact window between sponsor and investigators, carrying out all monitoring activities where relevant and necessary to the trial and the trial sites [3,4].”
BackgroundData Collection and Quality Control
Friedman, L. M., Furberg, C. D., & DeMets, D. L. (2010) · Springer eBooks · doi:10.1007/978-1-4419-1586-3_11 · Cited by 4 · see citing works
Data Capture, Data Management, and Quality Control; Single Versus Multicenter Trials
Knust, K., Yesko, L., Case, A., & Bickett, K. (2022) · Springer eBooks · doi:10.1007/978-3-319-52636-2_40 · Cited by 2 · see citing works
Serebruany, V. L. (2011) · Cardiology · doi:10.1159/000335476 · Cited by 2 · see citing works
Cybersecurity, Research Data Management (RDM), and Regulatory Compliance in Clinical Trials
Gomase, V. S. (2025) · Reviews on Recent Clinical Trials · doi:10.2174/0115748871360236250901072442 · Cited by 1 · see citing works
Stabile, S., Testoni, S., Scarpi, E., Franchina, V., Mannozzi, F., Betti, M., Ferrari, A., & Cagnazzo, C. (2026) · Journal of Pharmaceutical Innovation · doi:10.1007/s12247-026-10837-y · Cited by 1 · see citing works
“Given their cross-site responsibilities, CRAs and CTMs provide a unique, transversal view of site operations, offering valuable insights into both the organizational potential and the operational challenges associated with the presence of CRCs and SNs [ 7, 13, 15, 16].”
Striebich, S., Mattern, E., Oganowski, T., Schäfers, R., & Ayerle, G. M. (2021) · BMC Medical Research Methodology · doi:10.1186/s12874-021-01429-0 · Cited by 1 · see citing works
Publications from Clinical Trials
Hawkins, B. S. (2022) · Springer eBooks · doi:10.1007/978-3-319-52636-2_184 · Cited by 1 · see citing works
Cheyne, H. (2008) · Stirling Online Research Repository (University of Stirling) · Cited by 1 · see citing works
Data Collection and Management in Clinical Research
Guralnik, M. (2012) · Springer eBooks · doi:10.1007/978-1-4614-3360-6_7
Integration of Smart Home Health Data in the Clinical Decision Making Process
Helmer, A., Müller, F., Lohmann, O., Thiel, A., Kretschmer, F., Eichelberg, M., & Hein, A. (2014) · Communications in computer and information science · doi:10.1007/978-3-662-44485-6_24
Mathew, S. R., Lucas, K. D., Sayre, S. L., Bettencourt, J., Collins, T., Leach, D. D., Olson, R., Taylor, D. A., & Moyé, L. A. (2014) · PubMed
Clinical trials management at company level
Murphy, N. (2012) · Cambridge University Press eBooks · doi:10.1017/cbo9780511977640.009
A Statistical Model for Risk-Based Monitoring of Clinical Trials
Hather, G. J. (2016) · ICSA book series in statistics · doi:10.1007/978-3-319-42568-9_16
Translational Biomarkers: Application in the Clinical Development of Combination Therapies
Sukumar, S., & Caculitan, N. G. (2018) · Springer eBooks · doi:10.1007/978-981-13-0496-5_12
Data Capture, Data Management, and Quality Control; Single Versus Multicenter Trials
Knust, K., Yesko, L., Case, A., & Bickett, K. (2020) · Springer eBooks · doi:10.1007/978-3-319-52677-5_40-1
Publications from Clinical Trials
Hawkins, B. S. (2020) · Springer eBooks · doi:10.1007/978-3-319-52677-5_184-1
Striebich, S., Mattern, E., Oganowski, T., Schäfers, R., & Ayerle, G. M. (2021) · Research Square · doi:10.21203/rs.3.rs-331325/v1
Ikehara, Y., Morimoto, T., Ikeda, M., Node, K., & Ueda, S. (2023) · Rinsho yakuri/Japanese Journal of Clinical Pharmacology and Therapeutics · doi:10.3999/jscpt.54.1_9
Malle, A. B., Pawar, S. D., Pal, P. S., & Mulani, S. A. (2023) · International Journal of Pharmaceutical Sciences Review and Research · doi:10.47583/ijpsrr.2023.v83i01.007
Investigation on the occupational situation of clinical research associates in China
Du, C., Han, Q., Lu, Z., & Li, J. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1499237
Olsen, M. H., Hansen, M. L., Safi, S., Jakobsen, J. C., Greisen, G. O., & Gluud, C. (2021) · Figshare · doi:10.6084/m9.figshare.15087467
Olsen, M. H., Hansen, M. L., Safi, S., Jakobsen, J. C., Greisen, G., & Gluud, C. (2021) · Figshare · doi:10.6084/m9.figshare.15087464
専門医アワードを受賞して −多職種連携の架け橋としての臨床薬理学専門医−
肥田, 典. (2026) · Rinsho yakuri/Japanese Journal of Clinical Pharmacology and Therapeutics · doi:10.3999/jscpt.57.2_18
Aljadani, G. H., Alsaywid, B. S., AlTurkostani, J., & Lytra, C.-C. (. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-27743-6.00012-9
Olsen, M. H., Hansen, M. L., Engstrøm, J., Safi-Rasmussen, S., Greisen, G. O., Gluud, C., the SafeBoosC-III Trial Group, Pellicer, A., Bargiel, A., Hopper, A. O., et al. (2026) · BMC Medical Research Methodology · doi:10.1186/s12874-026-02932-y
“Moreover, it tends to focus on random errors [12, 13], which have little to no influence on the estimated intervention effect [2, 4].”
- Authors
- Williams, G. W.
- Affiliations
- Amgen (United States) (US)
- Corresponding author
- Williams, George W
- Venue
- Clinical Trials
- Publisher
- SAGE Publications
- Published
- 2006-12
- Volume
- 3
- Issue
- 6
- Pages
- 530-537
- ISSN
- 1740-7745 (ISSN-L)
- 1740-7753
- OpenAlex
- W2035489083
- Cited by
- 45
- References
- 15
- Citations by year
- 2026: 4 · 2025: 3 · 2023: 2 · 2022: 2 · 2021: 7 · 2020: 4 · 2018: 1 · 2016: 1 · 2015: 1 · 2014: 4 · 2013: 5 · 2012: 3
- FWCI
- 0.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Trials (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmaceutical industry and healthcare
- Keywords
- clinical trial monitoring, data quality, procedural adherence, data monitoring committees, investigator qualifications, site selection, quality control, adverse event reporting, patient safety, regulatory compliance
- MeSH terms
- Decision Making, Humans, Quality Control, Research Design, Randomized Controlled Trials as Topic, Adverse Drug Reaction Reporting Systems, Risk Assessment, Patient Selection, Clinical Trials Data Monitoring Committees
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