Project #193:
Incidence and management of inflammatory rheumatic diseases before, during and after the COVID-19 pandemic

Rationale: Rheumatoid arthritis, lupus and vasculitis are autoimmune rheumatological diseases that require prompt diagnosis and treatment to prevent serious complications. Whether COVID-19-related disruption has impacted on care for patients with these conditions remains unclear. Care quality is currently assessed via a National Audit programme, called NEIAA; however, data collection is burdensome for patients and clinicians, often incomplete, and was paused during the pandemic. OpenSAFELY provides an opportunity to address this knowledge gap, and change the way we measure care quality in the NHS.

In a previous pilot study, we used OpenSAFELY to evaluate care quality for NHS patients with rheumatoid arthritis during the pandemic (Lancet Rheumatology. 2023). We showed falls in new diagnoses, but no worsening in assessment or treatment delays. There were important limitations with these pilot analyses, however, which we will address in this project:

• We will explore how to address missing information on GP referrals using linked referral-to-treatment (RTT) data in OpenSAFELY; • We will describe variation in care at national, regional and hospital levels; • We will highlight care quality for connective tissue diseases and vasculitis, for which data on pandemic impact are lacking.

Aim: To describe the impact of the COVID-19 pandemic on healthcare delivery for patients newly diagnosed with autoimmune rheumatological conditions in England, identifying variation in care and the speed of recovery.

Methods: For individuals with new diagnostic codes for inflammatory arthritis, connective tissue diseases or vasculitis in their primary care records, we will describe trends in the following quality metrics aligned to national guidelines:

i) Numbers of new diagnoses and time to diagnosis; ii) Patterns of treatment initiation and escalation; iii) Frequency of disease-related flares and complications.

We will use time-series models to compare these metrics between pre-pandemic (March 2015 to Feb 2020), early pandemic (March 2020 to Feb 2021), later/post-pandemic recovery periods (March 2021 to August 2025).

Expected outputs: By sharing our findings via publications and with the Healthcare Quality Improvement Partnership, our goal is to reduce variation in care across NHS providers. This will set a precedent for the monitoring of care quality using routinely-captured data, reducing the burden of data collection on clinicians and patients.