Measuring implementation of clinical guidelines through the COVID-19 pandemic, using linked national health records: a national study of type 2 diabetes in England
Abstract
Objectives: To examine the conformance to type 2 diabetes NICE guidelines across cardiovascular risk strata; and to quantify geographical variation in treatment pathways following the COVID-19 pandemic, encompassing guideline changes.
Design: We carried out a retrospective observational study using linked electronic health records across England. Process mining, a data driven method that can reconstruct clinical treatment pathways, was applied to map 12-month treatment trajectories after treatment initiation. Conformance with NICE NG28 (2022) was quantified using a structural similarity index. Further, behavioural and entropy-based similarity (capturing treatment variability and complexity) measures were used to assess sequencing and heterogeneity of treatment.
Setting: Primary and secondary care in England datasets within the National Health Service England Secure Data Environment (NHSE SDE), analysed first at national level and then across 42 Integrated Care Boards (ICBs) which are the devolved health care geographical delivery regions in England.
Participants: 822,650 individuals with newly diagnosed T2DM between 1-February-2022 and 1-November-2025, stratified into low cardiovascular risk (LR-C; QRISK3=10 or receiving statins/blood pressure lowering treatment), and established cardiovascular disease (eCVD-C). Participants were followed for 12 months after first dispensed glucose lowering therapy.
Main outcome measure: First line therapy, treatment intensification and…
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