Spondyloarthritis quality standard

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Following the publication of the guideline Spondyloarthritis in over 16s: diagnosis and management by the National Institute for Health Care and Excellence (NICE) in February 2017, which saw recommendations under the following headings:

  • recognition and referral in non-specialist care settings
  • diagnosing spondyloarthritis in specialist care settings
  • information and support
  • pharmacological management of spondyloarthritis
  • non-pharmacological management of spondyloarthritis
  • surgery for spondyloarthritis
  • managing flares
  • long-term complications
  • organisation of care

The institute has taken a further step to embed these under a process called NICE quality standards.

The NICE Quality Standards Programme was established in 2009 to manage the development of quality standards, and sits within NICE’s Health and Social Care Directorate. NICE quality standards are central to supporting the Government’s vision for an NHS and Social Care system focused on delivering the best possible outcomes for people who use services, as detailed in the Health and Social Care Act (2012).

What is a NICE quality standard?

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a set of specific, concise statements and related measures that are:

  • derived from evidence-based guidance, such as NICE guidance or NICE accredited guidance
  • produced collaboratively with the NHS, social care or public health organisations, along with their partner organisations, people using services and carers.

Evidence from the underpinning guidance relating to people’s experience of care or services, safety issues, equality and resource impact is considered during the development process.

NICE quality standards do not provide a comprehensive service specification. They define priority areas for quality improvement based on consideration of the topic area.

The key to developing standard is to produce meaningful statements that can be measured and improve outcomes. The following are quality statements produced for spondyloarthritis and published in June 2018:

Statement 1 Adults with suspected axial or peripheral spondyloarthritis are referred to a rheumatologist.

Statement 2 Adults with suspected axial spondyloarthritis and an X‑ray that does not show sacroiliitis have an MRI using an inflammatory back pain protocol.

Statement 3 Adults with axial spondyloarthritis are referred to a specialist physiotherapist for a structured exercise programme.

Statement 4 Adults with spondyloarthritis are given information about their condition, which healthcare professionals will be involved with their care, and how and when to get in touch with them.

The full quality standard is available at this link

Improving outcomes

This quality standard is expected to contribute to improvements in the following outcomes:

  • functional capacity
  • mobility
  • work productivity
  • health-related quality of life
  • pain
  • fatigue
  • mortality rates from cardiovascular disease
  • joint replacement surgery
  • disease activity.

It is also expected to support delivery of the Department of Health's outcome frameworks.

Expected levels of achievement for quality measures are not specified. Quality standards are intended to drive up the quality of care, and so achievement levels of 100% should be aspired to (or 0% if the quality statement states that something should not be done). However, this may not always be appropriate in practice. Taking account of safety, shared decision-making, choice and professional judgement, desired levels of achievement should be defined locally.

As a supporting organisation PAPAA recognises the benefit of this quality standard in improving care. We will help with promotion of the standard where possible, and through our work, to promote it to commissioners and service providers.