The Oxford Royal College of General Practitioners Clinical Informatics Digital Hub: Protocol to Develop Extended COVID-19 Surveillance and Trial Platforms

Lusignan, Simon de; Jones, Nicholas; Dorward, Jienchi; Byford, Rachel; Liyanage, Harshana; Briggs, John; Ferreira, Filipa; Akinyemi, Oluwafunmi; Amirthalingam, Gayatri; Bates, Chris; Dabrera, Gavin; Eavis, Alex; Elliot, Alex J; Feher, Michael; Krajenbrink, Else; Hoang, Uy; Howsam, Gary; Leach, Jonathan; Okusi, Cecilia; Nicholson, Brian D; Nieri, P; Sherlock, Julian; Smith, Gillian; Thomas, Mark A.; Thomas, Nicholas; Tripathy, Manasa; Victor, William; Williams, John; Wood, Ian; Zambon, Maria; Parry, John; O’Hanlon, Shaun; Joy, Mark; Butler, Chris; Marshall, Martin; Hobbs, F D Richard

doi:10.2196/19773

Cited by 53 publications

(52 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is the largest study examining the association between blood pressure and COVID-19 outcomes conducted in community-dwelling patients with hypertension. The ORCHID hub 20 is capable of weekly data downloads permitting some of the most timely and up to date analysis of primary care data in the world. Data from secondary care are not available in such a timely manner in the United Kingdom, and for this analysis, it was not possible to link primary care data to hospital databases or the national death registry.…”

Section: Discussionmentioning

confidence: 99%

“…This study used a retrospective observational cohort study design, utilizing electronic health records from general practices in England contributing to the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID). 18 – 20 The ORCHID hub is representative of patients attending English primary care across urban and nonurban practices. 19 The protocol for this study was approved by Royal College of General Practitioners Research Surveillance Centre (RCGP RSC) scientific advisory committee and received ethical approval from the University of Oxford, Medical Sciences Interdivisional Research Ethics Committee (ref: R54893/RE001).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Association Between Blood Pressure Control and Coronavirus Disease 2019 Outcomes in 45 418 Symptomatic Patients With Hypertension

et al. 2021

Self Cite

View full text Add to dashboard Cite

Hypertension has been identified as a risk factor for COVID-19 and associated adverse outcomes. This study examined the association between pre-infection blood pressure (BP) control and COVID-19 outcomes using data from 460 general practices in England. Eligible patients were adults with hypertension who were tested or diagnosed with COVID-19. BP control was defined by the most recent reading within 24months of the index date (01/01/2020). BP was defined as controlled (<130/80mmHg), raised (130/80-139/89mmHg), stage 1 uncontrolled (140/90-159/99mmHg) or stage 2 uncontrolled ({greater than or equal to}160/100mmHg). The primary outcome was death within 28 days of COVID-19 diagnosis. Secondary outcomes were COVID-19 diagnosis and COVID-19 related hospital admission. Multivariable logistic regression was used to examine the association between BP control and outcomes. Of the 45,418 patients (mean age 67 years; 44.7% male) included, 11,950 (26.3%) had controlled BP. These patients were older, had more co-morbidities and had been diagnosed with hypertension for longer. A total of 4,277 patients (9.4%) were diagnosed with COVID-19 and 877 died within 28 days. Individuals with stage 1 uncontrolled BP had lower odds of COVID-19 death (OR 0.76, 95%CI 0.62-0.92) compared to patients with well-controlled BP. There was no association between BP control and COVID-19 diagnosis or hospitalisation. These findings suggest BP control may be associated with worse COVID-19 outcomes, possibly due to these patients having more advanced atherosclerosis and target organ damage. Such patients may need to consider adhering to stricter social-distancing, to limit the impact of COVID-19 as future waves of the pandemic occur.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Association Between Blood Pressure Control and Coronavirus Disease 2019 Outcomes in 45 418 Symptomatic Patients With Hypertension

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…This will entail a wide range of clinical event data, including collection of monitored conditions, vaccine exposure, AEIs, hospital admissions, intensive care, and deaths, to monitor approved study outcomes and for any unexpected public health emergencies. Effective interoperability and communication will be facilitated by monthly pseudonymized linkage, facilitated by NHS (National Health Service) Digital and PHE [ 7 ], to secondary care and other data sources, including Secondary Uses Service, the continuously updated source of hospital data (see Textbox 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…The RCGP RSC data set includes all coded data and all prescribed items, including vaccine exposure [ 3 ]. To manage our extended network of practices, we have set up a new analytics hub: the Oxford–Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Influenza and Respiratory Virus Surveillance, Vaccine Uptake, and Effectiveness at a Time of Cocirculating COVID-19: Protocol for the English Primary Care Sentinel System for 2020-2021

Lusignan¹,

Bernal²,

Byford³

et al. 2021

JMIR Public Health Surveill

Self Cite

View full text Add to dashboard Cite

Background The Oxford–Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) are commencing their 54th season of collaboration at a time when SARS-CoV-2 infections are likely to be cocirculating with the usual winter infections. Objective The aim of this study is to conduct surveillance of influenza and other monitored respiratory conditions and to report on vaccine uptake and effectiveness using nationally representative surveillance data extracted from primary care computerized medical records systems. We also aim to have general practices collect virology and serology specimens and to participate in trials and other interventional research. Methods The RCGP RSC network comprises over 1700 general practices in England and Wales. We will extract pseudonymized data twice weekly and are migrating to a system of daily extracts. First, we will collect pseudonymized, routine, coded clinical data for the surveillance of monitored and unexpected conditions; data on vaccine exposure and adverse events of interest; and data on approved research study outcomes. Second, we will provide dashboards to give general practices feedback about levels of care and data quality, as compared to other network practices. We will focus on collecting data on influenza-like illness, upper and lower respiratory tract infections, and suspected COVID-19. Third, approximately 300 practices will participate in the 2020-2021 virology and serology surveillance; this will include responsive surveillance and long-term follow-up of previous SARS-CoV-2 infections. Fourth, member practices will be able to recruit volunteer patients to trials, including early interventions to improve COVID-19 outcomes and point-of-care testing. Lastly, the legal basis for our surveillance with PHE is Regulation 3 of the Health Service (Control of Patient Information) Regulations 2002; other studies require appropriate ethical approval. Results The RCGP RSC network has tripled in size; there were previously 100 virology practices and 500 practices overall in the network and we now have 322 and 1724, respectively. The Oxford–RCGP Clinical Informatics Digital Hub (ORCHID) secure networks enable the daily analysis of the extended network; currently, 1076 practices are uploaded. We are implementing a central swab distribution system for patients self-swabbing at home in addition to in-practice sampling. We have converted all our primary care coding to Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) coding. Throughout spring and summer 2020, the network has continued to collect specimens in preparation for the winter or for any second wave of COVID-19 cases. We have collected 5404 swabs and detected 623 cases of COVID-19 through extended virological sampling, and 19,341 samples have been collected for serology. This shows our preparedness for the winter season. Conclusions The COVID-19 pandemic has been associated with a groundswell of general practices joining our network. It has also created a permissive environment in which we have developed the capacity and capability of the national primary care surveillance systems and our unique public health institute, the RCGP and University of Oxford collaboration.

show abstract

“…We conducted a retrospective nationwide cohort study, utilising electronic health records from primary care practices in England contributing to the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID). 18 The participating practices were representative of English primary care across urban and non-urban practices. 19 Two experienced PPI participants commented on the protocol and the research aims.…”

Section: Designmentioning

confidence: 99%

Changes in cardiovascular disease monitoring in English primary care during the COVID-19 pandemic: an observational cohort study

Bankhead

Lay-Flurrie

Nicholson

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

ObjectiveTo quantify the impact and recovery in cardiovascular disease monitoring in primary care associated with the first COVID-19 lockdown.DesignRetrospective nationwide primary care cohort study, utilising data from 1st January 2018 to 27th September 2020.SettingWe extracted primary care electronic health records data from 514 primary care practices in England contributing to the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID). These practices were representative of English primary care across urban and non-urban practices.ParticipantsThe ORCHID database included 6,157,327 active patients during the study period, and 13,938,390 patient years of observation (final date of follow-up 27th September 2020). The mean (SD) age was 38±24 years, 49.4% were male and the majority were of white ethnicity (65% [21.9% had unknown ethnicity])ExposureThe primary exposure was the first national lockdown in the UK, starting on 23rd March 2020.Main outcome measuresRecords of cholesterol, blood pressure, HbA1c and International Normalised Ratio (INR) measurement derived from coded entries in the primary care electronic health record.ResultsRates of cholesterol, blood pressure, HbA1c and INR recording dropped by 23-87% in the week following the first UK national lockdown, compared with the previous week. The largest decline was seen in cholesterol (IRR 0.13, 95% CI 0.11 to 0.15) and smallest for INR (IRR 0.77, 95% CI 0.72 to 0.81).Following the immediate drop, rates of recorded tests increased on average by 5-9% per week until 27th September 2020. However, the number of recorded measures remained below that expected for the time of year, reaching 51.8% (95% CI 51.8 to 51.9%) for blood pressure, 63.7%, (95% CI 63.7% to 63.8%) for cholesterol measurement and 70.3% (95% CI 70.2% to 70.4%) for HbA1c. Rates of INR recording declined throughout the previous two years, a trend that continued after lockdown. There were no differences in the times series trends based on sex, age, ethnicity or deprivation.ConclusionsCardiovascular disease monitoring in English primary care declined substantially from the time of the first UK lockdown. Despite a consistent recovery in activity, there is still a substantial shortfall in the numbers of recorded measurements to those expected. Strategies are required to ensure cardiovascular disease monitoring is maintained during the COVID-19 pandemic.

show abstract

The Oxford Royal College of General Practitioners Clinical Informatics Digital Hub: Protocol to Develop Extended COVID-19 Surveillance and Trial Platforms

Cited by 53 publications

References 23 publications

Association Between Blood Pressure Control and Coronavirus Disease 2019 Outcomes in 45 418 Symptomatic Patients With Hypertension

Association Between Blood Pressure Control and Coronavirus Disease 2019 Outcomes in 45 418 Symptomatic Patients With Hypertension

Influenza and Respiratory Virus Surveillance, Vaccine Uptake, and Effectiveness at a Time of Cocirculating COVID-19: Protocol for the English Primary Care Sentinel System for 2020-2021

Changes in cardiovascular disease monitoring in English primary care during the COVID-19 pandemic: an observational cohort study

Contact Info

Product

Resources

About