Study: Eleven key measures for monitoring general practice clinical activity during COVID-19 using federated analytics on 48million adults’ primary care records through OpenSAFELY. Image Credit: ratlos / Shutterstock

11 key measures to monitor clinical activity during COVID-19

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In a recent study published in the medRxiv*preprint server, researchers in the UK described key measures to monitor clinical activity during the coronavirus disease 2019 (COVID-19) pandemic.

The COVID-19 pandemic has significantly affected the capacity and delivery of primary and secondary care. After the first wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in March 2020, the team found that not all clinical activities had returned to near-normal levels by December 2020, as predicted by the National Health Service (NHS) England guidance was published in July 2020. This required a large amount of data analysis, which could be considered more than clinical and commissioning teams could reasonably monitor. Therefore, the team proposed essential primary care clinical activity metrics to facilitate routine monitoring, focused action, and informed response to the COVID-19 pandemic in light of our work and in partnership with the advisory group. clinical.

Study: Eleven key measures to monitor general practice clinical activity during COVID-19 using federated analytics on primary care records of 48 million adults through OpenSAFELY. Image Credit: ratlos / Shutterstock

About the study

In this study, researchers developed important primary care activity metrics and described their trends during the COVID-19 pandemic.

The team conducted a retrospective cohort analysis using electronic health record (EHR) data from a primary care general practitioner (GP) in GP practices in England. Within the OpenSAFELY platform, all data was securely linked, archived and analyzed. Pseudonymized information, including coded diagnoses, medications and physiological measurements, and all adult patients in England who were alive and registered with an EMIS or TPP GP from January 2019 to December 2021 at the start of each month. The team also obtained demographic factors such as age, gender, geographic location of practice address, ethnicity, and multidimensional deprivation index (MDI).

A clinical advisory panel comprised of leading pathologists, national clinical advisors; general practitioners and front-line pharmacists; and clinical and research professionals from the Bennett Institute came together to develop important markers of NHS clinical activity. In all, the team produced a significant number of graphs showing the differences in clinical coding activity across various clinical domains using the CTV3 terminology coding hierarchy. The clinical advisory panel manually analyzed these charts for each clinical area in multiple online meetings to identify clinical themes that could be enriched by continued observation and focused action.

The clinical advisory panel was asked to make recommendations for each therapeutic area, considering the following factors: high-volume utilization, clinical relevance to front-line practice, and whether the factors are more generally indicative of other problems with NHS service delivery. . Following these recommendations, the Bennett Institute team created custom lists of codes by hand. Charts related to the newly designed measures were then provided to the clinical advisory committee for final evaluation and a paragraph explaining why it was crucial to monitor each measure.

The team tabulated the total number of practices using each code list, the number of different patients who experienced events during the trial, and the number of events each patient experienced. Median and deciles of monthly coding activity rates were then determined for all practices.


The study cohort comprised 48,352,770 registered adult patients from 6,389 practices, representing more than 98% of all practices in England. In partnership with a clinical advisory panel, 11 important indicators of clinical activity were created to guide NHS service restoration in general practice. Regular blood tests, assessments of ongoing conditions, cardiovascular disease (CVD) risk assessments, and blood pressure monitoring were some of these crucial procedures. The team found 447 million recorded occurrences between January 2019 and December 2021, corresponding to the 11 measures.

Between January 2019 and December 2021, COPD screening measures reported 1.16 million patients and blood pressure monitoring was performed on 27.77 million, representing 2.6 million and 79.3 million patients. encoded events, respectively. The team also found that the median practice level rate for 1,000 registered patients was between 1.10 for COPD screening and 65.03 for blood pressure monitoring.

Medians for all metrics in April 2020 were much lower than April 2019, ranging from a 91.75% decrease in cholesterol tests to a 36.42% decrease in medication reviews. For April 2021, there was a median decrease compared to April 2019 of 42.03% for blood pressure monitoring and 1.65% for thyroid testing. Based on the SRO classification system, activity in all six blood monitoring parameters had recovered to within 15% of baseline by April 2021. All remaining measurements were considered to have had a sustained decline. In 2020, there were decreases in check-ups for COPD and asthma of 39.89% and 72.73%, respectively. From April 2019 to April 2021, the rates of 10-year blood pressure control and cardiovascular risk assessment decreased by 42.03% and 37.74%, respectively.

Overall, the study findings demonstrated an open source software framework that described trends and variations in clinical activity in a large volume of primary care data. The researchers believe that publicly accessible NHS OpenSAFELY SRO dashboards, equipped with near real-time data, will effectively monitor a more significant number of critical performance indicators on a regular basis in the future.

*Important news

medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore should not be considered conclusive, guide clinical practice or health-related behavior, or be treated as established information.

Magazine Reference:

  • Eleven Key Measures to Monitor General Practice Clinical Activity During COVID-19 Using Federated Analytics in Primary Care Records of 48 Million Adults via OpenSAFELY, Louis Fisher, Helen J Curtis, Richard Croker, Milan Wiedemann, Victoria Speed , Christopher Wood, Andrew Brown, Lisa EM Hopcroft, Rose Higgins, et al, medRxiv 2022.10.17.22281058, DOI:, 10.1101/2022.10.17.22281058v1

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