Background/Purpose: Axial spondyloarthritis (axSpA) is a chronic inflammatory disease affecting 1.4% of the US adult population.  The leading clinical symptom of axSpA is chronic inflammatory back pain (IBP) with onset before age 45 years.  Diagnostic delay and under recognition of the disease results in poor long-term outcomes.  Moreover, current healthcare shortages impose higher demands on healthcare providers and limit their ability to adequately manually screen for underlying conditions such as axSpA.  To address these challenges, this study aimed to assess the impact of implementing an automated IBP screening tool into the electronic health record (EHR) on the identification of axSpA in both new and established patients in a community rheumatology practice.

Methods: A validated and accepted (IBP) screening tool was integrated into the EHR patient intake form through an innovative partnership between NextGen Healthcare, Ecosystem partners, and a large community rheumatology practice (12 clinics) in the Southwest US.  Customized alerts were automatically generated by the EHR and sent to the treating rheumatologist for review.  Additional customized EHR query sets were employed to identify patients who may have initially been missed. New patients were defined as those with a first or second visit that occurred during the study period of October 2021 to October 2023. Established patients were defined as those with a third or subsequent visit that occurred before January 1, 2023.

Results: Among 19,875 new patients screened, 1,457 (7.3%) had a positive IBP screening form. Of patients with a positive IBP result, 180 (12.4%) were subsequently diagnosed with axSpA. A separate analysis of 94,606 established patients identified 223 patients (0.24%) who had a positive IBP screening form, and of these, 61 (27.4%) had a subsequent diagnosis of axSpA. Ultimately, a total of 14.3% of all positive IBP screening forms resulted in a diagnosis of axSpA.

Conclusion: Implementation of an automated IBP screening tool into the EHR within community practices may help with the rapid identification of patients with axSpA, leading to earlier diagnosis. This can reduce existing gaps in care by identifying patients within an existing practice who have been missed, and potentially improve long-term outcomes as a result of earlier initiation of therapeutic intervention.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hiding-in-plain-sight-the-impact-of-implementing-an-automated-inflammatory-back-pain-screening-tool-on-the-identification-of-axial-spondyloarthritis-in-a-community-rheumatology-practice/