Collecting data through the National Early Inflammatory Arthritis Audit (NEIAA) website

The NEIAA website collects information on patients seen in rheumatology departments in England and Wales. It gathers information on all new patients over 16 with suspected inflammatory arthritis.

Situation

There is compelling evidence that early intensive treatment significantly improves the outcome of these disabling diseases, which predominantly affect people of working age.

Aspiration

The aim of the NEIAA website is to improve the quality of care for people living with inflammatory arthritis. This will be achieved by assessing the performance of rheumatology units across England and Wales against NICE quality standards.

The website will help clinicians improve the quality of care for patients and control their joint inflammation.

For patients, the aim is that they will be more aware of their care and more able to take control of their health.

Solution

The NEIAA website is a data collection tool used by both clinicians and patients.

Information is gathered during the first 12 months of patients receiving care. It’s collected from the 1st appointment for all patients with suspected inflammatory arthritis or axial spondyloarthropathy. Data is collected 2 more times across the 12 months.

Data points include:

• waiting times
• the time to treatment
• the clinical response to treatment
• if education is provided
• patient-reported outcomes

Impact

Since 2018, almost 50,000 patients have been recruited to the audit.

It’s the largest database of patients with early inflammatory arthritis.

Data from the audit will inform research and planning to improve health, care and services.

Functionality

• The website is managed by Net Solving and is fully encrypted to NHS standards.
• Data is collected using 2 web tools, 1 for clinicians and 1 for patients.
• It includes real-time data analysis.
• Users can access resources such as driver diagrams.

The website has 6 forms:

• organisational data for your unit
• demographics
• diagnosis
• baseline
• 3 month follow-up
• 12 month follow-up

Capabilities

• Clinicians who are site admins receive weekly reminder emails with a list of patients due for a follow up in the next month.
• Clinicians can download their data and create personalised reports for evaluation and service improvements.
• All released patient data is anonymised.

Scope

• At home, patients can access forms through the website using their email address.
• Patients without internet access or who do not wish to use this option can use a paper questionnaire at the clinic. Their answers are then uploaded to the clinician website by staff in the rheumatology department.

Digital equalities

Patients can still use paper questionnaires if they do not have access to the internet. Their responses are uploaded to the clinician website.

Key figures and quotes

Key improvements from the 2nd annual report include:

• 47% of patients were referred within 3 working days from their GP (vs 41% in year 1)
• 48% of patients saw a rheumatologist within 3 weeks (vs 38% in year 1)
• 64% of patients started treatment within 6 weeks of referral (vs 54% in year 1)

Prompt and aggressive treatment for early inflammatory arthritis makes remission more achievable than ever before. The latest NEIAA shows that 80% of East Kent Hospitals University NHS Foundation Trust’s patients are in remission.

A 2019 audit of Frimley Health NHS Foundation Trust identified it as an outlier as 24% of patients were assessed within 3 weeks of referral. Yet within a year, the Trust dramatically turned this around. The latest data shows that 72% of patients were seen within the NICE quality standards.

Sunderland Royal Hospital had 10 to 12 early arthritis slots every week but still could not improve its NICE quality standard 2 (QS2). 24% of patients were seen within 3 weeks of referral. Since changing the triage in March 2019, the QS2 improved from 24.8% to 66.1%.

“Ensure you are sharing information not just with your team, but with wider management. Change is always difficult, but if you can determine specific and achievable actions, it gives you confidence to drive change and make a difference.”

Dr Ravinder Sandhu, Consultant Rheumatologist, Dudley Group NHS Foundation Trust

“Recruiting patients to the audit is key as otherwise it’s difficult to know how well you’re doing. In our Trust, it’s a team effort with secretaries, specialist nurses, the audit team, and consultants all inputting data.”

Dr Farhan, Bari Consultant Rheumatologist, East Kent Hospitals University NHS Foundation Trust

“In our experience, paper patient questionnaires don’t work. One of the developments because of COVID is that technology has moved forward, so embrace that. Having PROMS in the background during annual review helps identify any problems. The pre-clinic integration of the PROMS data will make the annual review more efficient, effective and beneficial for patient care.”

Dr Jo Kitchen, Consultant Rheumatologist, Royal Berkshire NHS Foundation Trust

Find out more

Read more case studies on the NEIAA website

Key contact

British Society for Rheumatology

audit@rheumatology.org.uk