15 February 2024

In this month’s eLearning spotlight, we spoke to Dr Liz Price, Clinical Lead for the National Early Inflammatory Arthritis Audit (NEIAA). She talked to us about how the audit has changed and key findings from the five-year report published last year.

Can you tell us what the purpose of NEIAA is?

The Healthcare Quality Improvement Partnership (HQIP) originally commissioned the audit to measure performance against the NICE Quality Standards for Rheumatoid Arthritis to improve patient care across England and Wales. We also collect Patient Reported Outcome Measures (PROMs) which allows us to understand the difference that healthcare interventions make to people’s quality of life as well as data on delays to diagnosis and treatment.

How is NEIAA doing?

NEIAA is in a great place, but there is always room for improvement. As of April 2023, we recruited a total of 67,528. In the first year, we peaked at 21,215 and during the Covid-19 pandemic we dropped to 4,563 but last year we recovered and recruited 14,083.

Since April 2023, we have been recruiting only confirmed cases of EIA and from September 2023 HQIP has mandated the collection of cases of new connective tissue diseases (CTD) and vasculitis.

This year we have recruited just under 6,000 patients in total so far. We expected the Early Inflammatory Arthritis recruitment to drop as we are now only collecting confirmed cases. Last year only 38% of those referred with suspected Early Inflammatory Arthritis were confirmed to have it. We are on target to collect as many confirmed cases of Early Arthritis as last year.

What have you learned from being involved in this project?

The variance between departments is quite striking in terms of levels of recruitment, conversion rates (i.e., the number of those seen that have inflammatory arthritis), and delays in being seen and starting treatment. I have learned a lot by speaking to many of the clinicians within departments and liaising with the clinical and audit leads.

It’s apparent that some units are significantly understaffed and under-resourced and are trying their best to comply with the standards. We have tried to help by highlighting this to Trusts and encouraging them to work with their clinicians to improve performance.

From April 2023 the focus is moving away from being seen within three weeks to starting treatment within six weeks. The six-week treatment target is important as we have shown that patients who start treatment early have better outcomes at three and 12 months.

We had focused initially on the departments that had been flagged as outliers but now we’re focusing on the low recruiters and the few departments that have not engaged at all. Previously, those falling more than 2 SD below the mean for QS2 were flagged to the CQC. This is changing to look at QS3 (the six-week treatment target) and for the first time will include the low recruiters as well.

What are the key findings from the five-year report and what are the biggest challenges?

Time to rheumatology referral has improved, with 56% of patients being referred within three working days. However, our ability to see them within three weeks has reduced.

39% of patients are now seen within three weeks compared to 41% pre-pandemic. The message about treating early has got through with 56% of patients starting treatment within six weeks compared to 52% in year four.

The overall response to treatment hasn’t altered and about a third of patients have a good and another 30% a moderate response at the three-month time point. Clinically meaningful improvements are seen in PROMs by three months.

Moving forward, we want to see all departments engaging with the audit and aiming to recruit all their newly diagnosed early arthritis, CTD, and vasculitis, as this is the best way to measure incident diagnosis of rheumatic disease.

Could you summarise the most recent changes in data collection?

Various patient charities challenged us to broaden the audit to include diagnosis other than early inflammatory arthritis, and these challenges directly influenced the decision to expand the dataset to newly diagnosed connective tissue diseases and vasculitis.

When entering patients into the audit please make sure that you have confirmed the diagnosis – use the recognised criteria. We will be running some events clarifying diagnostic criteria to help with this over the next few months.

The audit lost its National Data Opt-out (NDO) status on the 7th July 2023. This means that any individual who has declared they do not want their data routinely collected should not automatically be included in the audit.  Audit departments should be able to help with this as they can interrogate the NHS Spine where this data is stored.

How can people access their own data?

You can use the drop-down menu under ‘Charts and Reports’ to access your own Trust data in summary reports, but please note that this is ‘raw’ data which may be subject to change. You can also see some data by region and Integrated Care Board (ICB) which allows you to compare yourself with others within region.

More comprehensive data sets can be downloaded. We are planning a webinar to go through this and show people how to access their data in a meaningful form.

If you’d like to get in touch, please contact Audit@rheumatology.org.uk.

Message for participating sites

Thank you for all the hard work you are doing and please keep recruiting! If you are struggling, then please contact me or the team at BSR.

We are getting in touch with outliers to support but if you need help with engagement from the audit department/ letters of support etc please get in touch.

Consider looking at triage if you haven’t already - this seems to be a key way to improve performance, getting the right people into the right slots. The average is 38% (have EIA in EIA clinic) but there is a wide range currently from 20-60%.