P003 Service Improvement of Collecting axSpA Disease Activity metrics at Mid Yorkshire Hospital Rheumatology Service
Authors: Shelton Tom P H , Jeffery Robert E 
Published: December 2024

Abstract

Background and aims
ASAS-EULAR guidance on the management of Axial Spondyloarthropathy (AxSpa) recommends regular collection of Disease Activity Metrics like Bath AxSpa Disease Activity Index (BASDAI) (Ramiro et al., 2022). NICE advocates use of BASDAI in disease management. Mid Yorkshire NHS Rheumatology service also collects BASFI and BASMI measures regularly (6-12 months). This has been historically collected by Physiotherapists. Staff time is at a premium and collection of AxSpa measures was recognised as an opportunity for improvement by utilising the team’s skills. This work mirrors other evaluations of collecting disease monitoring data (Labinsky et al., 2024). The aims of the service improvement project are to maintain collection of disease metrics to inform management of AxSpa and improving utilisation of staff skills.

Methods
Review of services between 2022/23 recommended educational investment in Non-Qualified Therapy staff (TIs) and use of digital patient management platforms (SystmOne) to improve collection of Disease Activity Metrics. A comprehensive training program was developed for non-qualified therapy staff with training materials and a supervision program to undertake metrics. Clinical processes were developed to allow assessments to be completed in 30 min. Developments included set up of clinics and remote collection of self-reported outcomes by email, text or telephone (validated by Ariza-Ariza et al., 2013). Development of use of SystmOne reduced data entry processes and facilitated collection of Disease Metrics remotely. Physiotherapist and non-qualified staff patient contact and contact time metrics were compared between 1/1/2022 to 7/8/2022 with 1/1/2023 to 7/8/2023, extracting data from SystmOne.

Results
Total time spent with patients completing AxSpa metrics and treatment increased from 149.78 hours in 2022 to 208.75 hours in 2023. There was a reduction in Physiotherapy time completing AxSpa measures from 145.28 hours to 128.75. TI staff have increased their involvement in completing AxSpa metrics; TI expending 80 hours over 97.5 contacts in 2023, compared to only 4.5 hours in 4 contacts in 2022.

Conclusions
Investment in training of non-qualified therapy staff to collect axSpa Disease Activity Metrics has improved staff utilisation; Upskilling the TIs and freeing Physiotherapists to be more involved in the treatment of patients. Increases in overall contact time requires further exploration of cause. Improvement of core processes of Disease Activity Metrics requires further ongoing auditing to understand how new roles and processes mature. There are further opportunities to link data collection to local tertiary centres to promote research activity and further exploration of self-reporting of metrics.

References
1. Ariza-Ariza R, et al. Rheumatol Int. 2013 Nov;33(11):2731-6.
2. Labinsky, H., et al. Rheumatol Int (2024); NICE. 2017. https://www.nice.org.uk/guidance/ng65. Accessed on May 9; 2024.
3. Ramiro S, et al. Ann Rheum Dis 2023;82:19-34.