Facilitate Quality Improvement Research Articles

The SWEDEHEART secondary prevention and cardiac rehabilitation registry (SWEDEHEART CR registry).

The quality registry SWEDEHEART covers data across the patient pathway after an acute myocardial infarction (MI), from hospital care to secondary prevention. Although cardiac rehabilitation (CR) is strongly recommended after an MI, there is still heterogeneity regarding standards, uptake, and adherence rates. The aim of the SWEDEHEART-CR registry is to provide continuous information on secondary prevention and CR performance to support the audit and development of evidence-based practice. To facilitate quality improvement and research initiatives, a description of the characteristics and development of the SWEDEHEART-CR registry is needed. The SWEDEHEART-CR registry starts with data obtained during hospital care and then collects data at out-patient visits 2 months and 1-year after discharge, and at start and end of an exercise-based CR programme. The registry data covers comorbidities, biochemistry, blood pressure, anthropometric variables, medication, psychosocial- and lifestyle variables, readmissions, patient-reported outcome measures, attendance in CR-related programmes, and physical fitness variables. Over 100 000 patients with MI have been included in the SWEDEHEART-CR registry since its start in 2005. From initially covering 35 centres (47%) and 2200 patients annually (27%), SWEDEHEART-CR has developed to a nation-wide registry with 75 centres (100%) and 8800 patients annually (80%) in 2020. The SWEDEHEART-CR registry includes a high proportion of the national MI population entering a CR programme and is a powerful tool for quality audit, improvement, and research. The registry provides insights into the characteristics, treatment, and outcomes of evidence-based secondary preventive practice, ultimately leading to better cardiovascular health.

Evaluating the Quality of Tuberculosis Contact Investigation in Cali, Colombia: A Retrospective Cohort Study.

Tuberculosis (TB) contact investigation facilitates earlier TB diagnosis and initiation of preventive therapy, but little data exist about the quality of its implementation. We conducted a retrospective cohort study to evaluate processes of TB contact investigation for index TB patients diagnosed in Cali, Colombia, in 2017, including dropout at each stage and overall yield. We constructed multivariable models to identify predictors of completing 1) the baseline household visit and 2) a follow-up clinic visit for TB evaluation among referred contacts. Sixty-eight percent (759/1,120) of registered TB patients were eligible for contact investigation; 77% (582/759) received a household visit. Odds of completing a household visit were significantly lower among men (adjusted odds ratio [aOR]: 0.6; 95% CI: 0.4-0.9; P = 0.009) and patients living in Cali's western zone (aOR: 0.5; 95% CI: 0.3-0.8; P = 0.008). Among 1880 screened contacts, 31% (n = 582) met the criteria for clinic referral, 47% (n = 271) completed a clinic visit, and 85% (231/271) completed testing. After adjusting for clustering by index patient, odds of completing referral were higher among contacts with cough (aOR: 22; 95% CI: 7.1-66; P < 0.001) and contacts living in the western zone (aOR: 4.1; 95% CI: 1.2-15; P = 0.03). The cumulative probability of a symptomatic contact from an eligible household completing TB evaluation was only 28%. The yield of active TB patients among contacts was only 0.3% (5/1880). Only 16% (17/103) of children aged < 5 years and none of the eight persons living with HIV, reported preventive therapy initiation. Routine monitoring of process indicators may facilitate quality improvement to close gaps in contact tracing and increase yield.

Constructing a new cost structure using time-driven activity-based costing for replanting at palm oil plantation

The palm oil industry in Malaysia is undeniably the pride of the country. However, in this plantation there are currently few issues which do not set up a time equation to interpret the variance of activities, the rate setting did not illustrate the correlation between the resources provided and the practical capacity, and the manager had no tool in place to monitor the unused capacity. In order to increase precision in the field of palm oil plantation, this work aims to develop a new cost structure. Time-driven activity-based costing (TDABC) has been introduced because it allows time output to be efficiently assessed, the idle capacity accurately defined, and the unused capacity separately to be recorded. This provides an overview of functional tools and their associated costs as well as measurement methods and facilitates quality improvement. This work focused only on replanting field and the plantation located in Pahang. The maximum replanting capacity cost rate (CCR), with 288600 minutes and 0.106 RM / minute, was subsequently successfully developed. Finally, the manager can observe that 68358.45 minutes of utilized capacity could be used for the systematic development of replanting capacity planning.

Automated identification and quality measurement for pediatric convulsive status epilepticus.

Treatment delays for refractory convulsive status epilepticus (RCSE) are associated with worse outcomes. In the United States, treatment for pediatric RCSE is slower than guidelines recommend. To address this gap, the American Academy of Neurology and Child Neurology Society (AAN/CNS) developed a quality measure: the percentage of RCSE patients that receive third-line treatment within 60minutes. We aimed to develop computable phenotypes for convulsive status epilepticus (CSE) and RCSE to automate calculation of the quality measure. From an observational cohort of children presenting to the emergency department for seizures or epilepsy, we identified presentations of RCSE and its precursors: CSE and benzodiazepine-resistant status epilepticus (BRSE). These served as a gold standard for computable phenotype development. Using multivariate analyses, we constructed and evaluated statistical models for case identification. We then evaluated adherence to the AAN/CNS RCSE quality measure. From 664 charts, we identified 56 patients with CSE, 36 with BRSE, and 18 with RCSE. Four predictors were used: International Classification of Diseases (ICD) codes, and receiving first-, second-, or third-line agents shortly after presentation to the emergency department (ED). Combinations of these predictors identified CSE with 84% sensitivity and 81% positive predictive value (PPV), BRSE with 67% sensitivity and 89% PPV, and RCSE with 94% sensitivity and 85% PPV. Median (interquartile range [IQR]) time to treatment for first-line agent was 13 (5-27) minutes for CSE, second-line for BRSE was 24 (9.5-43.5) minutes, and third-line for RCSE was 52 (27-87) minutes. Sixty percent of RCSE patients received a third-line agent within 60minutes of ED arrival. RCSE and its precursors can be identified automatically with high fidelity allowing automated calculation of time to treatment and the RCSE quality measure. This has the potential to facilitate quality improvement work and improve care for RCSE.

Philippine Performance Evaluation and Assessment Scheme (PPEAS): Experiences in Newborn Screening System Quality Improvement.

Newborn Bloodspot Screening (NBS) has existed for over 60 years, having been initiated by Guthrie in the U.S. In the Philippines, NBS was introduced in 1996 and later was supported by legislation. The NBS program now includes 29 conditions, covering 91.6% of the newborn population in 2019. Program growth and expansion necessitated development of a formal performance evaluation and assessment scheme (PEAS) for monitoring performance and for continuously improving quality. This study’s objective was to present the development, implementation, and results to date of the Philippine Performance PEAS (PPEAS). Using the comprehensive listing of laboratory and non-laboratory elements in the model PEAS system in the U.S., PPEAS tools were developed for critical Philippine NBS system components: regional Department of Health (national health agency, Philippines) (DOH) offices (CHDs), NBS laboratories (NSCs), NBS specimen submitters (NSFs), and long-term case management centers (NBSCCs). Data generated from the various PPEAS have been periodically reviewed and analyzed for NBS system impact. PPEAS were developed to facilitate quality improvement at various levels of the Philippine NBS system. PPEAS identified successes, gaps, and challenges to be addressed by NSCs, NSFs, CHDs, and NBSCCs with the assistance of the Newborn Screening Reference Center and the Department of Health.

Future Health Today: codesign of an electronic chronic disease quality improvement tool for use in general practice using a service design approach

ObjectiveTo codesign an electronic chronic disease quality improvement tool for use in general practice.DesignService design employing codesign strategies.SettingGeneral practice.ParticipantsSeventeen staff (general practitioners, nurses and practice managers) from general practice in...

Assessing the Quality of Evidence Presented at the Annual Conferences of Diabetes Canada

ObjectivesAnnual general meetings (AGMs) are often seen and promoted as great sources of contemporary information for the modern health-care professional. The quality of research evidence presented at these conferences, however, remains unclear. This paper evaluates the level of evidence (LoE) of research presented at the 2015 to 2019 AGMs of Diabetes Canada (DC). MethodsUsing the framework we first published to evaluate the LoE presented at the Canadian Society of Nephrology (CSN) AGMs, 2 authors independently assigned eligible abstracts a study type and grade. Research assistants separately recorded corresponding author and city affiliations. ResultsOf 832 published abstracts, 68% (N=568) met the inclusion criteria. These abstracts were classified as follows: 12% Level I (highest quality); 30% Level II; 36% Level III; 14% Level IV and 8% Level V (lowest quality). The LoE remained consistent over the 5-year study period, as observed by the Jonckheere–Terpstra test (p=0.754). The LoE of DC AGMs was similar to that of CSN AGMs (p=0.125). The number of authors was positively associated with improved LoE (p<0.001). ConclusionsBased on our novel auditing methodology, the LoE of DC AGMs is on par with other analyzed national AGMs. Adoption of this metric for all AGMs would aid in identifying unfavourable trends and alert planning and abstract selection committees of trends in LoE. Such studies will increase transparency for stakeholders and facilitate quality improvement initiatives.

Transforming surgical morbidity and mortality into a systematic case review

Background/PurposeThe surgical morbidity and mortality (M&M) conferences at a regional children's hospital achieved the goals of case by case peer review and education for trainees but provided limited data for trending and analysis. In 2019, an institution-wide effort was initiated to create an electronic case review system with the goals of improving event capture and real-time practice performance feedback. Surgical M&M was migrated to this structured case review format to provide a platform for surgical performance improvement. MethodsAn online secure database was created with a 3-step classification system based on Clavien-Dindo severity score, peer review, and causality fishbone analysis. The data entered were available in an interactive dashboard. Retrospective tabulation of the 2018 M&M data was performed using the archived paper system used prior to 2019. ResultsFor the calendar year of 2019, the division of pediatric surgery captured and categorized 193 complications in the case review system. The capture rate was 50 per 1000 surgical procedures. For a similar time frame in 2018, the capture rate was 35 per 1000 surgical procedures. The dashboard provided run charts of the incidence and types of complications by procedure and by surgeon. Similar trend data were not available in 2018. The dashboard output has made possible the creation of (non- risk adjusted) individual surgeon performance reports. The output has been used to direct process improvement projects and educational content. ConclusionCreation of an online database with interactive dashboard has allowed surgical M&M to evolve into a systematic case review that greatly facilitates quality improvement efforts. This system increased the event capture rate and provided novel practice performance feedback, resulting in process improvement projects and educational objectives predicated on the trending data. These electronic reporting tools are now available to all surgical divisions and represent a transformative approach to surgical case review. Type of StudyRetrospective Historical control; Quality improvement. Level of EvidenceLevel III.

Implementation of a learning healthcare system for sickle cell disease.

ABSTRCTObjectiveUsing sickle cell disease (SCD) as a model, the objective of this study was to create a comprehensive learning healthcare system to support disease management and research. A multidisciplinary team developed a SCD clinical data dictionary to standardize bedside data entry and inform a scalable environment capable of converting complex electronic healthcare records (EHRs) into knowledge accessible in real time.Materials and MethodsClinicians expert in SCD care developed a data dictionary to describe important SCD-associated health maintenance and adverse events. The SCD data dictionary was deployed in the EHR using EPIC SmartForms, an efficient bedside data entry tool. Additional data elements were extracted from the EHR database (Clarity) using Pentaho Data Integration and stored in a data analytics database (SQL). A custom application, the Sickle Cell Knowledgebase, was developed to improve data analysis and visualization. Utilization, accuracy, and completeness of data entry were assessed.ResultsThe SCD Knowledgebase facilitates generation of patient-level and aggregate data visualization, driving the translation of data into knowledge that can impact care. A single patient can be selected to monitor health maintenance, comorbidities, adverse event frequency and severity, and medication dosing/adherence.ConclusionsDisease-specific data dictionaries used at the bedside will ultimately increase the meaningful use of EHR datasets to drive consistent clinical data entry, improve data accuracy, and support analytics that will facilitate quality improvement and research.

Patient-centered approaches applied in inpatient and outpatient TB services in Armenia

Abstract Background Healthcare system performance indicators are common instruments measuring and facilitating quality improvement. The End-TB strategy urges provision of integrated patient-centered (PC) care for all forms of tuberculosis (TB). This study aimed to assess and compare quality of inpatient and outpatient TB services using international standards on specific PC indicators to identify potential targets for improvement. Methods Joint Commission International (JCI) accreditation standards, adapted to local needs and context, were used as a basic instrument for qualitative and quantitative data collection. We utilized Patient and Family Right (PFR) and Patient and Family Education (PFE) 15 standards with 49 measurable elements as PC indicators for the nationwide assessment of TB services. A scoring system and a scaling approach were used to convert all-source-data and present the overall performance of services. Results We reviewed and analyzed data from 10 legal documents, 34 medical records and 155 interviews and focus group discussions with TB healthcare providers, patients and family members from inpatient and outpatient TB services to define the degree of compliance of their practices and treatment experiences to JCI standards. Outpatient TB services met the PFR and PFE standards at the 51%-level receiving a grading of partially performed and requiring improvements. The inpatient services met the PFR and PFE standards at 39%- and 26%-level respectively, receiving a grading of minimally performed for the JCI standards, showing statistically significantly less patient centeredness compared to the outpatient services (p = 0.007, CI 0.234; 0.4234), and requiring major improvements. Conclusions Strengthening interventions towards patient-centeredness are essential in both inpatient and outpatient services, but Armenia needs to put more emphasis on inpatient care to bridge the gap between the existing and recommended practices.

Why Registries are Important: The Example of the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI).

Why Registries are Important: The Example of the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI).

Hearing the voices of looked-after children: Considering the challenges of obtaining feedback on healthcare services.

The voices of looked-after children (LAC) are rarely heard in health services or research. Obtaining feedback on services from children and adolescents and involving them in decision-making is important; yet communicating with vulnerable groups, like LAC, is not straightforward. Improving communication practices and ways of gaining feedback can facilitate quality improvement across healthcare. Using focus groups with 49 LAC aged 5-17 years, we identified three core themes. First, feedback tools need to be child-centred and LAC-friendly; second, tools should be gender-neutral and developmentally appropriate; and third, the current UK feedback tool was not fit for purpose. If feedback tools for children and adolescents are unfit for purpose, then any quality improvement and changes to services made are not sufficiently paying attention to this important population.

Interprofessional student teams focus on staff issues while learning about quality improvement

ABSTRACT There is a well-known gap between what we know and what we do within healthcare service processes. Models that facilitate quality improvement (QI) have seen used to eliminate these gaps. Knowledge and competence in QI work are necessary for every professional within the healthcare system and are ideally learned through interprofessional collaboration and introduced during undergraduate studies. To meet these competence needs, Linköping University, Sweden, in collaboration with the main healthcare provider in the region, implemented a 2-week interprofessional QI learning module, which is mandatory for all undergraduate healthcare students. Ideas for practice-based QI projects were introduced to all the students who studied theory in the relevant domains of QI while working on these projects. A content analysis of students’ written reports was conducted to investigate the focus of the projects. The analysis showed that most projects (65%) concerned staff-related issues, while 35% had patient perspectives. This distribution changed over time, increasing the number of patient centered projects.

The Society of Thoracic Surgeons General Thoracic Surgery Database: 2020 Update on Outcomes and Research

The Society of Thoracic Surgeons General Thoracic Surgery Database (GTSD) remains the largest and most robust thoracic surgical database in the world. The GTSD provides participant sites with risk-adjusted performance reports for benchmarking and facilitates quality improvement initiatives. In addition the GTSD provides several mechanisms for high-quality research using data from over 283 participant sites and nearly 620,000 procedures since its inception in 2002. Participant sites are audited at random annually to ensure continued completeness and accuracy of the GTSD. In 2020 the GTSD migrated to a cloud-based interactive data platform, and the Task Force continues to refine the data collection form to decrease data entry burden while maintaining data quality, granularity, and relevance. This report provides an update on outcomes, volume trends, and database improvements as well as a summary of research productivity resulting from the GTSD over the preceding year.

Quality improvement tool for rapid identification of risk factors for SARS-CoV-2 infection among healthcare workers

SummaryThe rapid growth of the coronavirus disease 2019 (COVID-19) pandemic, limited availability of personal protective equipment, and uncertainties regarding transmission modes of severe acute respiratory syndrome coronavirus-2 have heightened concerns for the safety of healthcare workers (HCWs). Systematic studies of occupational risks for COVID-19 in the context of community risks are difficult and have only recently started to be reported. Ongoing quality improvement studies in various locales and within many affected healthcare institutions are needed. A template design for small-scale quality improvement surveys is proposed. Such surveys have the potential for rapid implementation and completion, are cost-effective, impose little administrative or workforce burden, can reveal occupational risks while taking community risks into account, and can be repeated easily with short time intervals between repetitions. This article describes a template design and proposes a survey instrument that is easily modifiable to fit the particular needs of various healthcare institutions in the hope of beginning a collaborative effort to refine the design and instrument. These methods, along with data management and analytic techniques, can be widely useful and shared globally. The authors' goal is to facilitate quality improvement surveys aimed at reducing the risk of occupational infection of HCWs during the COVID-19 pandemic.

Grading variation in 2,934 patients with ductal carcinoma in situ of the breast: the effect of laboratory- and pathologist-specific feedback reports

BackgroundHistologic grade of ductal carcinoma in situ of the breast (DCIS) may become the single biomarker that decides whether patients will be treated. Yet, evidence shows that grading variation in daily practice is substantial. To facilitate quality improvement, feedback reports, in which laboratory-specific case-mix adjusted proportions per grade were benchmarked against other laboratories, were sent to the individual laboratories by March 1, 2018. One year later, the effect of these feedback reports on inter-laboratory variation was studied.MethodsSynoptic pathology reports of all pure DCIS resection specimens between March 1, 2017 and March 1, 2019 were retrieved from PALGA (the nationwide Dutch pathology registry). Laboratory-specific proportions per grade were compared to the overall proportion in the year before and after feedback. The absolute deviation for all three grades at once, represented by the overall deviation score (ODS), was calculated as the sum of deviations from the grade-specific overall proportions. Case-mix adjusted, laboratory-specific odds ratios (ORs) for high- (grade III) versus low-grade (grade I-II) DCIS were obtained by multivariable logistic regression.ResultsOverall, 2954 DCIS reports from 31 laboratories were included. After feedback, the range between laboratories decreased by 22 and 6.5% for grades II and III, while an increase of 6.2% was observed for grade I. Both the mean ODS (27.2 to 24.1%) and maximum ODS (87.7 to 59.6%) decreased considerably. However, the range of case-mix adjusted ORs remained fairly stable and substantial (0.39 (95% CI: 0.18–0.86) to 3.69 (95% CI: 1.30–10.51)).ConclusionA promising decrease in grading variation was observed after laboratory-specific feedback for DCIS grades II-III, while this was not observed for DCIS grade I. Overall, grading variation remained substantial which needs to be addressed considering its clinical implications. Nationwide consensus on a classification, and training of (expert breast) pathologists, for example by e-learning, may help to further improve grading standardization.

Cerebral Palsy Research Network Clinical Registry: Methodology and Baseline Report

ObjectiveTo apply practice-based evidence to clinical management of cerebral palsy (CP). The process of establishing purpose, structure, logistics, and elements of a multi-institutional registry and the baseline characteristics of initial enrollees are reported. DesignA consensus-building process among consumers, clinicians, and researchers used a participatory action process. SettingCommunity, hospitals, and universities. ParticipantsMore than 100 clinicians, researchers, and consumers and more than 1858 enrollees in the registry. Main Outcome MeasuresNot applicable. ResultsConsensus was that the purpose of registry was to (1) quantify practice variation, (2) facilitate quality improvement (QI), and (3) perform comparative effectiveness research (CER). Collecting data during routine clinical care using the electronic medical record was determined to be a sustainable plan for data acquisition and management. Clinicians from multiple disciplines defined salient characteristics of individuals and interventions for the registry elements. The registry was central to the clinical research network, and a leadership structure was created. A leading electronic health record platform adopted the registry elements. Twenty-four sites have initiated the data collection process and agreed to export data to the registry. Currently 12 are collecting data. Number of enrollees and characteristics were similar to other population registers. ConclusionsThis is the first multi-institutional CP registry that contains the patient and treatment characteristics needed for QI and CER. The Cerebral Palsy Research Network registry elements are implemented in a versatile electronic platform and minimize burden to clinicians. The resultant registry is available for any institution to participate and is growing rapidly.

Variation in breast cancer grading: the effect of creating awareness through laboratory-specific and pathologist-specific feedback reports in 16 734 patients with breast cancer

AimsHistological grade is widely used to guide the management of invasive breast cancer (IBC). Yet, substantial interlaboratory and intralaboratory grading variations exist in daily pathology practice. To create awareness and...

The PCORnet Blood Pressure Control Laboratory: A Platform for Surveillance and Efficient Trials.

Uncontrolled blood pressure (BP) is a leading preventable cause of death that remains common in the US population despite the availability of effective medications. New technology and program innovation has high potential to improve BP but may be expensive and burdensome for patients, clinicians, health systems, and payers and may not produce desired results or reduce existing disparities in BP control. The PCORnet Blood Pressure Control Laboratory is a platform designed to enable national surveillance and facilitate quality improvement and comparative effectiveness research. The platform uses PCORnet, the National Patient-Centered Clinical Research Network, for engagement of health systems and collection of electronic health record data, and the Eureka Research Platform for eConsent and collection of patient-reported outcomes and mHealth data from wearable devices and smartphones. Three demonstration projects are underway: BP track will conduct national surveillance of BP control and related clinical processes by measuring theory-derived pragmatic BP control metrics using electronic health record data, with a focus on tracking disparities over time; BP MAP will conduct a cluster-randomized trial comparing effectiveness of 2 versions of a BP control quality improvement program; BP Home will conduct an individual patient-level randomized trial comparing effectiveness of smartphone-linked versus standard home BP monitoring. Thus far, BP Track has collected electronic health record data from over 826 000 eligible patients with hypertension who completed ≈3.1 million ambulatory visits. Preliminary results demonstrate substantial room for improvement in BP control (<140/90 mm Hg), which was 58% overall, and in the clinical processes relevant for BP control. For example, only 12% of patients with hypertension with a high BP measurement during an ambulatory visit received an order for a new antihypertensive medication. The PCORnet Blood Pressure Control Laboratory is designed to be a reusable platform for efficient surveillance and comparative effectiveness research; results from demonstration projects are forthcoming.

Abstract P5-02-12: The effect of laboratory-specific feedback reports on grading variation of invasive breast cancer; results of a nationwide study in the Netherlands

Abstract Background: To date, histologic grade is widely used to guide therapeutic management of invasive breast cancer (IBC), as it remains one of the most well established prognostic biomarkers. In the Netherlands, with similar guidelines to the rest of Europe, grade even indicates the need for adjuvant chemotherapy in approximately one third of breast cancer patients. However, we previously showed that inter- and intra-laboratory variation in grading is substantial in daily pathology practice. To facilitate quality improvement of histologic grading, feedback reports were sent to all individual pathology laboratories. Reports included the case-mix adjusted laboratory proportions per grade, benchmarked against other laboratories and the nationwide average. Hence, pathologists were enabled to discuss and reflect upon their grading practices. We assessed the effect of these feedback reports on grading variation in daily pathology practice on a nationwide level. Methods: Synoptic pathology reports of all IBC resection specimens, obtained between March 1 2017 and March 1 2019 were retrieved from the Dutch nationwide pathology registry (PALGA). Feedback reports were sent on March 1 2018. Absolute differences in laboratory-proportions of grades I-III were compared to the overall nationwide proportion before (March 1, 2017 to March 1, 2018) and after the laboratories received their feedback reports (March 2, 2018 to March 1, 2019) from PALGA. To compare the absolute deviation for all grades at once, a SUM-score, representing the sum of deviations from the grade-specific nationwide proportions, was calculated. Case-mix correction was performed by multivariable logistic regression, providing laboratory-specific odds ratios (ORs) for high (grade II-III) versus low-grade (grade I) IBC. The multivariate ORs before and after the feedback reports were compared by Wilcoxon signed rank test. Results: We included 17,102 synoptic IBC reports from 33 laboratories of which 8,676 were reported before and 8,335 were reported after the feedback reports were sent. Nationwide proportions before and after the feedback reports were 30.5% and 32.0% for grade I, 49.5% and 49.2% for grade III, and 20.0% and 18.8% for grade III, respectively. After feedback, the total range between laboraratories decreased for all grades; from 17.5-45.5% to 17.3%-41.5% for grade I (range -3.8%), from 34.3-64.5% to 35.0-58.8% for grade II (range -6.4) and from 10.9%-37.1% to 9.9-29.5% for grade III (range -6.6%). The maximum SUM-score of 34.1% before the feedback reports decreased to 29.4% after feedback. However, SUM-scores per laboratory before and after the feedback reports did not significantly differ (Wilcoxon signed rank test, p=0.955). Furthermore, comparison of the multivariate ORs confirmed that changes were not significant (Wilcoxon signed rank test, p=0.640). Conclusion: After implementation of feedback reports, an encouraging decrease in nationwide grading variation was observed, reflected by the decrease of the absolute range between laboratories after the feedback reports for all grades (I-III) and the decrease of the maximum overall deviation (SUM-score). As feedback reports were sent by PALGA for the first time, this was not (yet) a closed quality loop. Hence, we do not know if and how laboratories implemented the feedback reports. Therefore, although feedback reports seem to decrease grading variation, the full potential of these reports is still unclear. However, overall grading variation remains substantial, which emphasizes that continuous monitoring and benchmarking is essential as it creates insight and awareness. Closing the quality loop and further training of pathologists, for example by e-learning, may help to further decrease grading variation and improve clinical decision making. Citation Format: Carmen van Dooijeweert, Paul J van Diest, Inge O Baas, Elsken van der Wall, Ivette AG Deckers. The effect of laboratory-specific feedback reports on grading variation of invasive breast cancer; results of a nationwide study in the Netherlands [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-02-12.