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

Objectives To assess the delay in the diagnosis of axial SpA (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 and 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 and 366 (37%) had axSpA. There was a progressive increase in the number of females with axSpA. The mean time to diagnosis significantly decreased from 9.8 years (s.d. 1.2) in 2008 to 1.0 years (s.d. 1.0) in 2023. The greatest delay was from the onset of back pain to first seeing their general practitioners (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 organizational change in triage, referral and clinic pathways has led to earlier recognition of axSpA. This is further enhanced through an integrated education program and awareness campaign for the public, GPs and healthcare professionals, including physiotherapists. With continuous quality improvement cycles, we achieved our aim of reducing the mean time to diagnosis to 1 year. What does this mean for patients?Axial spondyloarthritis (axSpA) is a condition that can affect the spine, joints and other parts of the body. It can result in pain, stiffness, fatigue and loss of joint movement. If left untreated it can result in loss of the ability to carry out activities of daily living and a reduction in quality of life. There is a delay in the time it takes to diagnose axSpA and this can be as long as 8.5 years in the UK. In this service improvement project, we describe the factors that contribute to the delay and steps we have taken over a 16-year period to reduce the time to diagnosis of axSpA to 1 year. This involved changing the structure of the service that delivered the care of axSpA in the community, primary and secondary care. This involved greater collaboration across all sectors to implement a joined-up care pathway for axSpA patients. An integrated education program that supported the development of healthcare professionals (HCPs) in identifying and referring patients with suspected axSpA to the rheumatologist was implemented. Earlier diagnosis of axSpA will allow earlier treatment of the condition, which will lead to better outcomes for patients in the future.