The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
Oxford Health Foundation Trust, Warneford Hospital, Oxford, United Kingdom.
Elife. 2023 Jul 27;12:e84673. doi: 10.7554/eLife.84673.
The COVID-19 pandemic has had a significant impact on delivery of NHS care. We have developed the OpenSAFELY Service Restoration Observatory (SRO) to develop key measures of primary care activity and describe the trends in these measures throughout the COVID-19 pandemic.
With the approval of NHS England, we developed an open source software framework for data management and analysis to describe trends and variation in clinical activity across primary care electronic health record (EHR) data on 48 million adults.We developed SNOMED-CT codelists for key measures of primary care clinical activity such as blood pressure monitoring and asthma reviews, selected by an expert clinical advisory group and conducted a population cohort-based study to describe trends and variation in these measures January 2019-December 2021, and pragmatically classified their level of recovery one year into the pandemic using the percentage change in the median practice level rate.
We produced 11 measures reflective of clinical activity in general practice. A substantial drop in activity was observed in all measures at the outset of the COVID-19 pandemic. By April 2021, the median rate had recovered to within 15% of the median rate in April 2019 in six measures. The remaining measures showed a sustained drop, ranging from a 18.5% reduction in medication reviews to a 42.0% reduction in blood pressure monitoring. Three measures continued to show a sustained drop by December 2021.
The COVID-19 pandemic was associated with a substantial change in primary care activity across the measures we developed, with recovery in most measures. We delivered an open source software framework to describe trends and variation in clinical activity across an unprecedented scale of primary care data. We will continue to expand the set of key measures to be routinely monitored using our publicly available NHS OpenSAFELY SRO dashboards with near real-time data.
This research used data assets made available as part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant ref MC_PC_20058).The OpenSAFELY Platform is supported by grants from the Wellcome Trust (222097/Z/20/Z); MRC (MR/V015757/1, MC_PC-20059, MR/W016729/1); NIHR (NIHR135559, COV-LT2-0073), and Health Data Research UK (HDRUK2021.000, 2021.0157).
COVID-19 大流行对国民保健制度的医疗服务产生了重大影响。我们开发了 OpenSAFELY 服务恢复观测站 (SRO)，以开发初级保健活动的关键措施，并描述整个 COVID-19 大流行期间这些措施的趋势。
在获得英格兰国民保健制度的批准后，我们开发了一个开源软件框架，用于管理和分析数据，以描述初级保健电子健康记录 (EHR) 数据中 4800 万成年人的临床活动趋势和变化。我们为初级保健临床活动的关键措施开发了 SNOMED-CT 编码列表，例如血压监测和哮喘评估，这些措施由一个专家临床咨询小组选择，并进行了基于人群的队列研究，以描述 2019 年 1 月至 2021 年 12 月期间这些措施的趋势和变化，并在大流行一年后根据实践水平率的中位数变化，灵活地将其恢复水平分类。
我们生成了 11 个反映一般实践临床活动的措施。在 COVID-19 大流行开始时，所有措施的活动都大幅下降。到 2021 年 4 月，中位数率已恢复到 2019 年 4 月中位数率的 15%以内。其余措施显示出持续下降，从药物评估减少 18.5%到血压监测减少 42.0%不等。到 2021 年 12 月，仍有三个措施持续下降。
COVID-19 大流行与我们开发的大多数措施中的初级保健活动发生了重大变化，大多数措施都有所恢复。我们提供了一个开源软件框架，用于描述初级保健数据前所未有的规模上的临床活动趋势和变化。我们将继续使用我们公开的 NHS OpenSAFELY SRO 仪表板扩展一系列关键措施，以便使用近乎实时的数据进行常规监测。
这项研究使用了作为数据和连接国家核心研究的一部分提供的数据资产，该研究由英国健康数据研究中心领导，与国家统计局合作，并由英国研究与创新署资助（资助编号 MC_PC_20058）。OpenSAFELY 平台得到了惠康信托基金（222097/Z/20/Z）；医学研究理事会（MR/V015757/1、MC_PC-20059、MR/W016729/1）；英国国家卫生研究院（NIHR）（NIHR135559、COV-LT2-0073）和英国健康数据研究中心（HDRUK2021.000、2021.0157）的支持。
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