Progressive improvement in time to diagnosis in axial spondyloarthritis through an integrated referral and education system

Abstract

Objectives To assess the delay in the diagnosis of axSpA in a real world cohort over a 16 year period and to evaluate factors associated with this delay. We implemented a service improvement project and evaluated its effectiveness in improving time to diagnosis of axSpA. Methods A cohort of axSpA patients newly diagnosed between January 2008 to December 2023, were studied. Surveys were carried out in 2013, 2017, 2019 and 2023 to assess time to diagnosis which was divided into four periods from onset of inflammatory back pain to year of axSpA diagnosis. The time to diagnosis over the study period was analysed using a statistical process control chart. Results Over the study period, 988 referrals were received where 366 (37%) had axSpA. There was a progressive increase in the number of females with axSpA. The mean (SD) time to diagnosis significantly reduced from 9.8 (1.2) years in 2008 to 1.0 (1.0) year in 2023. The greatest delay was from the onset of back pain to first seeing their GPs (mean 3.2 years). There was a significant improvement in the mean time to diagnosis across the time periods through the service improvement interventions. Conclusion Structural and organisational change in triage, referral and clinic pathways has led to earlier recognition of axSpA. This is further enhanced through an integrated educational programme and awareness campaign for the public, GPs and healthcare professionals including physiotherapists. With continuous quality improvement cycles, we achieved our aim to reduce mean time to diagnosis to1 year.