Chan Antoni, Rigler Kathryn, Ahmad Nadia, Lafont Tanguy
University Department of Rheumatology, Royal Berkshire NHS Foundation Trust, Reading, UK.
Rheumatol Adv Pract. 2024 Aug 23;8(4):rkae102. doi: 10.1093/rap/rkae102. eCollection 2024.
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.
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.
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.
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.
评估在16年期间一个真实世界队列中轴性脊柱关节炎（axSpA）的诊断延迟情况，并评估与该延迟相关的因素。我们实施了一项服务改进项目，并评估其在改善axSpA诊断时间方面的有效性。
对2008年1月至2023年12月期间新诊断的axSpA患者队列进行研究。在2013年、2017年、2019年和2023年进行调查，以评估诊断时间，从炎性背痛发作到axSpA诊断年份分为四个时期。使用统计过程控制图分析研究期间的诊断时间。
在研究期间，共收到988份转诊，其中366例（37%）患有axSpA。患有axSpA的女性数量逐渐增加。诊断的平均时间从2008年的9.8年（标准差1.2）显著下降到2023年的1.0年（标准差1.0）。最大的延迟是从背痛发作到首次就诊于全科医生（平均3.2年）。通过服务改进干预措施，各时间段的平均诊断时间有显著改善。
分诊、转诊和门诊流程中的结构和组织变革导致了对axSpA的更早识别。通过针对公众、全科医生和包括物理治疗师在内的医疗保健专业人员的综合教育项目和宣传活动，这一情况得到了进一步加强。通过持续的质量改进循环，我们实现了将平均诊断时间缩短至1年的目标。
