NEIA Audit | British Society for Rheumatology

NEIA audit (NEIAA) aims to improve the quality of care for people living with inflammatory arthritis, collecting information on all new patients over the age of 16 in specialist rheumatology departments in England and Wales.

Commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit Programme, the National Early Inflammatory Arthritis Audit is carried out by BSR with support from King's College London and Netsolving.

The audit generates service-level data across England and Wales, benchmarked to regional and national comparators against NICE Quality Standard 33 and other key metrics.

Data is collected for patients with a diagnosis of Early Inflammatory Arthritis (EIA) across 12 months, assessing waiting times, time to treatment, clinical response to treatment and patient-reported outcomes. The audit now also collects data at diagnosis for some rare immune mediated inflammatory diseases (IMIDs).

Submit data to the audit

NEIAA measures the quality of care delivered to patients, aged 16 and above, seen in specialist secondary care rheumatology clinics in England and Wales with suspected and newly diagnosed inflammatory arthritis. The audit reports against five key metrics of care:

time to referral
time to assessment
time to treatment
response to treatment
patient reported outcome measures (PROMs).

Report

State of the nation report: analyses data from patients recruited between 1 April 2023 and 31 March 2023
Infographic: key findings from the year 5 annual report
Data Tables: displays data that sits behind the key findings of the year 5 report.
Service Level data spreadsheet: displays data from the year 5 report by service.
Podcasts: executive summary and a more in-depth look at the national recommendation


QI Plan
Quality Improvement Plan: A report outlining the improvement goals of NEIAA

Acknowledgements

This report was prepared by members of the NEIAA operations team, using data provided by patients and staff within the NHS. The key messages and national recommendations have been co-produced with the NEIAA senior governance group, project working group and patient panel. The continued success of this national clinical audit is due to the hard work and commitment of the rheumatology clinical community and patients, and everybody who gives their time to support the BSR audit team. Thank you.

We are particularly grateful to all the clinical and administrative staff and patients who contribute data to NEIAA during what continues to be a challenging time in healthcare.

King’s College London (KCL)
The Centre for Rheumatic Diseases at King’s College London has provided methodological and analytical support for NEIAA from its outset.

Net Solving
Established in 2001, Net Solving has spent over a decade perfecting the art of clinical data collection. It has revolutionised the way clinical data collection is conducted by pioneering the move to integrated online data collection methods, leveraging the latest technology to provide highly accurate data collection and analysis. Its market-leading platform CaseCapture™ is the culmination of 15 years’ experience in creating many of the largest clinical data collection web platforms in the UK and worldwide. Net Solving is wholly committed to its continuing work with BSR on NEIAA.

Governance and patient involvement

NEIAA is carried out by the British Society for Rheumatology (BSR) with support from King’s College London and Netsolving.

BSR is the leading UK specialist medical society for rheumatology and musculoskeletal (MSK) care professionals. We support our members to deliver the best care at all stages of the care pathway, improving the lives of children and adults with rheumatic and MSK disease.
NEIAA has an independent patient panel, who have who have reviewed and contributed to key messages and national recommendations, and whose Chair and Deputy Chair sit on the Project Working Group.

The patient panel comprises:
- Paul Amlani-Hatcher (Chair)
- Roger Stevens (Deputy Chair)
- Kate Wilkins
- Ruth Williams
- Tom Esterine

The NEIAA senior governance and project working groups, convened by BSR, are composed of members of the rheumatology community, including representatives across the Multi-Disciplinary Team (MDT) as well as patient charities. They contributed towards the key messages and national recommendations in this State of the Nation report and provide ongoing support and guidance to the BSR team to ensure the programme is clinical led, relevant, impactful and stays on track.

Senior Governance Group (SGG)
- Sanjeev Patel, President, BSR (Chair) 
- Ali Rivett, CEO, BSR (Vice-Chair) 
- Ayas Syed, Assistant Divisional Director, Scheduled Care, ABUHB 
- Benjamin Ellis, Medical Lead, Arthritis Research UK (ARUK)  
- Clare Jacklin, CEO, National Rheumatoid Arthritis Society (NRAS) 
- Dale Webb, CEO, National Axial Spondyloarthritis Society (NASS) 
- Zoe McLaren, Chair, BSR Clinical Affairs Committee  
- Gary MacFarlane, Chief Investigator, BSRBR-AS (UoA) 
- James Galloway, Lead Methodologist, KCL 
- Jo Ledingham, BSR Clinical Audit Lead  
- Neena Garnavos, Head of Quality Improvement, BSR 
- Natalia Plejic, Healthcare Quality Improvement Partnership (HQIP) Project Manager 
- Peter Lanyon, Getting IT Right First Time (GIRFT) Clinical Lead 
- Sarah Campbell, Director of Practice and Quality, BSR 
- Rachael Ward-Sample, Healthcare Quality Improvement Partnership (HQIP) Associate Director  
- Sarah Gallagher, Project Manager, BSR 
- Callum Coalwood, Clinical Audit Administrator, BSR

Project Working Group (PWG)
- Jo Ledingham, BSR Clinical Audit Lead (Chair) 
- Zoe McLaren, Chair, BSR Clinical Affairs Committee (Vice-chair) 
- Sarah Gallagher, BSR Project Manager 
- James Galloway, Lead Methodologist, KCL 
- Martin Cripps, IT Project Manager, Netsolving 
- Paul Amlani-Hatcher, Patient Panel Chair 
- Roger Stevens, Patient Panel Deputy 
- Karl Gaffney, Consultant Rheumatologist, AxSpA Representative 
- Fiona Cramp, Nursing/AHP representative  
- Jill Firth, Nursing/AHP representative 
- Charlotte Sharp, Trainee Representative with QI Interest 
- Sarah Campbell, Director of Practice and Quality 
- Ilfita Sahbudin, Trainee Representative 
- Neena Garnavos, Head of Quality Improvement, BSR 
- Ed Alvelyn, Clinical Fellow, KCL 
- Lola Birch, Clinical QI Fellow, BSR 
- Callum Coalwood, Clinical Audit Administrator, BSR 
- Lizzie Macphie, Consultant Rheumatologist


Methods and measuring the data
Methods and Measuring the data: Scientific and lay summary of the methodology used.

References

- Russell MD Galloway JB Andrews CD et al. Incidence and management of inflammatory arthritis in England before and during the COVID-19 pandemic: a population-level cohort study using OpenSAFELY. The Lancet Rheumatology. 2022; 4: 12: E853-E863.

- Coates LC Conaghan PG D'Agostino MA et al. Remission in psoriatic arthritis—where are we now?. Rheumatology (Oxford). 2018; 57: 1321-1331

- O'Dell JR Treating rheumatoid arthritis early: a window of opportunity?. Arthritis Rheum. 2002; 46: 283-285

- Seo MR Baek HL Yoon HH et al. Delayed diagnosis is linked to worse outcomes and unfavourable treatment responses in patients with axial spondyloarthritis. Clin Rheumatol. 2015; 34: 1397-1405

- Fransen J, van Riel PL. The Disease Activity Score and the EULAR response criteria. Clin Exp Rheumatol. 2005 Sep-Oct;23(5 Suppl 39):S93-9. PMID: 16273792.

- British Society for Rheumatology. (2021). BSR Workforce Report: The Rheumatology Workforce in the UK 2021 [PDF]. Retrieved from https://rheumatology.org.uk/Po...

- British Society for Rheumatology. (2022). NEIAA Ethnicity Report [PDF]. Retrieved from https://www.rheumatology.org.u...

Previous Reports

2022

- Clinical annual report: analyses data from 11,722 patients, who were recruited between 1 April 2021 and 31 March 2022. Find out more

- Patient and public annual report: focused look at patients referred with suspected inflammatory arthritis, seen in a rheumatology clinic for the first time and followed up over three months. Find out more

- Supplementary report: displays data from the year 4 annual report by NHS region. Find out more

- Trust and health board data: provider-level organisational data and performance against each of the 2013 NICE Quality Statements. Find out more

- Annual report slide deck: key findings from the first year of the NEIAA (for presentations). Find out more

- Ethnicity report: explores the association between ethnicity and experience of care using data from May 2018 until March 2020. Find out more

- Supplementary report: contains further data tables to supplement the ethnicity report. Find out more

2021

- Clinical annual report: analyses data from 13,578 patients, who were recruited between 8 May 2019 – 7 May 2020. Find out more

- Patient and public annual report: focused look at patients referred with suspected inflammatory arthritis, seen in a rheumatology clinic for the first time and followed up over three months. Find out more

- Trust and health board data: provider-level admission, annual review and disease activity score data. Find out more


2020
- Supplementary report: focusing on the seventh metric (annual reviews) alongside 12-month clinician- and patient-reported outcome data. Find out more - Trust and health board data: provider-level admission, annual review and disease activity score data. Find out more

2019

- Clinical annual report: analyses data from 20,668 patients, who were recruited between 8 May 2018 and 7 May 2019. Find out more
- Patient and public annual report: focused look at patients referred with suspected inflammatory arthritis, seen in a rheumatology clinic for the first time and followed up over three months. Find out more
- Trust and health board data: provider-level organisational data and performance against each of the 2018 NICE Quality Statements. Find out more
- Annual report slideset: key findings from the first year of the NEIAA (for presentations). Find out more

2016

- Clinical annual report: analyses data from 5,002 patients, who were recruited between 1 February 2015 and 29 January 2016. Find out more
- Patient annual report: assesses the early management of patients referred to rheumatology providers with suspected inflammatory arthritis. Find out more
- 2016 annual report presentation of key findings. Find out more
- 2015 clinical annual report: analyses data on 6,354 patients, who were recruited to the audit between 1 February 2014 and 31 January 2015. Find out more
- 2015 patient annual report: in-depth look at patients over 16 years of age in England and Wales with suspected rheumatoid or other types of early inflammatory arthritis within the crucial first three months of referral to a specialist. Find out more
- 2015 annual report presentation of key findings: Find out more
- 2014-16 National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis case studies: Find out more

Resources

Webinars

Find out everything you need to know about the audit project, what data to collect and how, in a handy 30 minute webinar from audit lead analyst Dr James Galloway.

Driver diagrams

Driver diagrams show step-by-step approaches that identify multiple small interventions that influence the primary aim. There are context-specific facilitators and barriers to high-quality care at each site. Driver diagrams should be modified for local circumstances and involve input from across the MDT.

The driver diagrams can be edited and some spaces are left blank. Instructions for completion and further resources are in the ‘instructions’ tab at the bottom of the page within each diagram.

Clinic prompts

Developed by the NEIAA clinical team to support decision-making, these can be used as a training tool at induction and for educational interventions.

There are prompts for new suspected inflammatory arthritis, the review of inflammatory arthritis patients, and newly-diagnosed axial spondyloarthritis.

NICE QS33

QS33 covers assessing, diagnosing and managing rheumatoid arthritis in over 16s. It describes high-quality care in priority areas for improvement. This guidance was initially published in June 2013 and was updated in January 2020.

It provides guidance on the quality of care that healthcare professionals should deliver and also informs patients, service users and carers on what they should expect.

The January 2020 version covers five quality statements around referral, treatment, patient education, rapid access to specialist care and annual review. QS2 on assessment and QS5 on disease control were removed. BSR was a supporting organisation in reviewing the standards, as we recognise the benefit of updating it to improve care.

NB: we currently use QS2 for outlier ascertainment in this audit, and will continue to do so until further notice, as it is still referenced as supported by evidence and is useful at a local level.

Archive reports and case studies

2020

Supplementary report: focusing on the seventh metric (annual reviews) alongside 12-month clinician- and patient-reported outcome data. Find out more
Trust and health board data: provider-level admission, annual review and disease activity score data. Find out more

2019

Clinical annual report: analyses data from 20,668 patients, who were recruited between 8 May 2018 and 7 May 2019. Find out more
Patient and public annual report: focused look at patients referred with suspected inflammatory arthritis, seen in a rheumatology clinic for the first time and followed up over three months. Find out more
Trust and health board data: provider-level organisational data and performance against each of the 2018 NICE Quality Statements. Find out more
Annual report slideset: key findings from the first year of the NEIAA (for presentations). Find out more

2016

Clinical annual report: analyses data from 5,002 patients, who were recruited between 1 February 2015 and 29 January 2016. Find out more
Patient annual report: assesses the early management of patients referred to rheumatology providers with suspected inflammatory arthritis. Find out more
2016 annual report presentation of key findings. Find out more
2015 clinical annual report: analyses data on 6,354 patients, who were recruited to the audit between 1 February 2014 and 31 January 2015. Find out more
2015 patient annual report: in-depth look at patients over 16 years of age in England and Wales with suspected rheumatoid or other types of early inflammatory arthritis within the crucial first three months of referral to a specialist. Find out more
2015 annual report presentation of key findings: Find out more
2014-16 National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis case studies: Find out more

National Early Inflammatory Arthritis Audit

NEIA audit (NEIAA) aims to improve the quality of care for people living with inflammatory arthritis, collecting information on all new patients over the age of 16 in specialist rheumatology departments in England and Wales.

Submit data to the audit

Submit data to the audit

Access the report here

Report

QI Plan

Quality Improvement Plan: A report outlining the improvement goals of NEIAA

Acknowledgements

Governance and patient involvement

Methods and measuring the data

Methods and Measuring the data: Scientific and lay summary of the methodology used.

References

2022

2021

2020

- Supplementary report: focusing on the seventh metric (annual reviews) alongside 12-month clinician- and patient-reported outcome data. Find out more - Trust and health board data: provider-level admission, annual review and disease activity score data. Find out more

2019

2016

Webinars

Find out everything you need to know about the audit project, what data to collect and how, in a handy 30 minute webinar from audit lead analyst Dr James Galloway.

Driver diagrams

The driver diagrams can be edited and some spaces are left blank. Instructions for completion and further resources are in the ‘instructions’ tab at the bottom of the page within each diagram.

NICE Quality Statement 4 Driver Diagram

Clinic prompts

Developed by the NEIAA clinical team to support decision-making, these can be used as a training tool at induction and for educational interventions.

There are prompts for new suspected inflammatory arthritis, the review of inflammatory arthritis patients, and newly-diagnosed axial spondyloarthritis.

QS33 covers assessing, diagnosing and managing rheumatoid arthritis in over 16s. It describes high-quality care in priority areas for improvement. This guidance was initially published in June 2013 and was updated in January 2020.

It provides guidance on the quality of care that healthcare professionals should deliver and also informs patients, service users and carers on what they should expect.

NB: we currently use QS2 for outlier ascertainment in this audit, and will continue to do so until further notice, as it is still referenced as supported by evidence and is useful at a local level.

Archive reports and case studies

2020

Supplementary report: focusing on the seventh metric (annual reviews) alongside 12-month clinician- and patient-reported outcome data. Find out more

Trust and health board data: provider-level admission, annual review and disease activity score data. Find out more

2019

Clinical annual report: analyses data from 20,668 patients, who were recruited between 8 May 2018 and 7 May 2019. Find out more

Patient and public annual report: focused look at patients referred with suspected inflammatory arthritis, seen in a rheumatology clinic for the first time and followed up over three months. Find out more

Trust and health board data: provider-level organisational data and performance against each of the 2018 NICE Quality Statements. Find out more

Annual report slideset: key findings from the first year of the NEIAA (for presentations). Find out more

2016

Clinical annual report: analyses data from 5,002 patients, who were recruited between 1 February 2015 and 29 January 2016. Find out more

Patient annual report: assesses the early management of patients referred to rheumatology providers with suspected inflammatory arthritis. Find out more

2016 annual report presentation of key findings. Find out more

2015 clinical annual report: analyses data on 6,354 patients, who were recruited to the audit between 1 February 2014 and 31 January 2015. Find out more

2015 patient annual report: in-depth look at patients over 16 years of age in England and Wales with suspected rheumatoid or other types of early inflammatory arthritis within the crucial first three months of referral to a specialist. Find out more

2015 annual report presentation of key findings: Find out more

2014-16 National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis case studies: Find out more

- Supplementary report: focusing on the seventh metric (annual reviews) alongside 12-month clinician- and patient-reported outcome data. Find out more

- Trust and health board data: provider-level admission, annual review and disease activity score data. Find out more