DRIVING IMPROVEMENT in AXIAL SPONDYLOARTHRITIS SERVICES: The USE of QUALITY IMPROVEMENT APPROACHES and TOOLS

ABSTRACT

Background: Quality Improvement (QI) methods have been used in healthcare since the late 1980s across a wide range of healthcare settings. However, in the UK they have not been applied widely within rheumatology including axial Spon-dyloarthritis (axial SpA). In 2017, the UK healthcare regulator, NICE, produced a national clinical guideline for axial SpA, but there was no mechanism to encourage uptake of its recommendations. The National Axial Spondyloarthritis Society created a programme to use QI approaches to help encourage uptake of the Guidelines and act as a catalyst for wider improvement in axial SpA care. Objectives: To encourage service improvement in axial Spondyloarthritis care through the use of quality improvement theory and methods. Methods: In late 2019 six rheumatology departments were selected to participate in the frst cohort. The programme design was underpinned by A framework for management grounded in systems theory1 A learning system that brings healthcare organisations together2 A set of tools to develop, test and implement changes the Model for Improvement3. The teams met four times for training in QI methods, plus team-based online coaching. They had time to develop their projects and networking opportunities to share their data and experiences of implementation. We conducted a qualitative review of the programme in year one. We interviewed 31 programme participants and reviewed programme documentation. Results: The review found that A proven QI framework provides a strong basis to build improvement A competitive programme helps foster motivation and accountability The programme provides the time to use tools to understand the problem and construct improvement aims Measurement is key to understand improvement and to create a story of change Collaboration and engagement is key within the team and with other stakeholders. The teams have • Trained community-based physiotherapists, leading to improved rheumatology referrals Implemented an infammatory back pain pathway from primary care Introduced an MRI spine IBP protocol to reduce variation in imaging Established a tertiary referral service which has improved time to diagnosis Implemented mental health interventions for patients and reduced the percentage of patients with abnormal scores Established a pathway for physiotherapy self-referral and reduced Did Not Attend rates Used audit to make the business case for an extended scope practitioner Conclusion: Despite the challenges of posed by the Covid-19 pandemic, a structured QI programme has enabled clinicians to stay engaged and implement projects to reduce diagnostic delay and improve care.