Project #100:
Management of Early Inflammatory Arthritis during the COVID-19 Pandemic

Rationale

The coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is the biggest challenge the National Health Service (NHS) has faced in living memory. For rheumatology services, the impact of the pandemic has been enormous, with appointments delayed, consultations shifted to telephone, and procedures cancelled. Variation across the country is inevitable and we have an opportunity to learn from each other.

The COVID-19 pandemic offers a unique opportunity to change the way we measure care quality in the NHS, reducing data burden and improving completeness. Care quality for rheumatoid arthritis (RA) services is currently assessed by the Health Quality Improvement Partnership (HQIP) National Early Inflammatory Arthritis Audit (NEIAA). The audit collects information across the first 12 months after diagnosis capturing performance against the NICE quality guidelines. However, data collection is burdensome for Trusts, often incomplete, and was paused during the COVID-19 pandemic.

Aim and Methods

Our goal is to use routinely collected data from electronic medical records through OpenSAFELY to describe the impact of the COVID-19 pandemic on the delivery of services to patients with newly diagnosed rheumatoid arthritis, identifying variations in care and in the speed of recovery across England.

We will describe: i) delays in the diagnosis of rheumatoid arthritis; ii) delays in the shared prescribing of treatments for rheumatoid arthritis with primary care; and iii) delays in escalating treatment for rheumatoid arthritis. We will analyse this data using an interrupted time-series model, which allows us to compare pre-COVID-19 and post COVID-19 periods from March 2020, with the post COVID-19 periods further split at the start of subsequent pandemic waves.

Expected output of project

We anticipate that the output of this project will contribute to a reduction in variation in care across NHS service providers. In the long term, this research will set a precedent for the monitoring of early rheumatoid arthritis care to be undertaken using routine captured data, reducing the burden of clinician level data entry for every patient seen.