Variation In Care Delivery Research Articles

Variation in Urology Care After Urinary Stone Surgery Among Veterans at High-risk for Recurrence

ObjectiveTo determine rates of urology follow-up and implementation of stone prevention measures after stone surgery and to assess variation in care delivery within a large, integrated healthcare system. Materials and MethodsWe used nationwide data from the United States Veterans Health Administration to identify patients who had stone surgery between 2016 and 2018 and who were at higher risk for recurrence. Our cohort included 13,444 Veterans across 90 facilities. We examined the proportion of patients who had a post-operative urology visit or who received a prevention measure (24-hour urine test, serum parathyroid hormone measurement, or prescription of a stone-related medication) within 6 months of stone surgery. We calculated the median odds ratio to quantify facility-level variation in urology care after stone surgery, adjusting for patient- and facility-level characteristics. ResultsWithin 6 months of stone surgery, 94.2% Veterans had a urology visit, yet only 8.8% completed 24-hour urine testing, 8.4% had a parathyroid hormone measurement, and 31.0% were prescribed a stone-related medication. Implementation of prevention measures varied widely across facilities with the median odds ratio ranging between 1.18 for medication prescriptions and 1.77 for 24-hour urine testing. ConclusionsWhile most patients have a urology visit after stone surgery, stone prevention measures were implemented infrequently and inconsistently for patients at higher risk for recurrence, indicating an opportunity for quality improvement.

Identification of gaps in the delivery of high-quality care of patients with eosinophilic esophagitis.

Quality indicators (QIs) are standardized metrics that can be used to quantify health care delivery and identify important areas for practice improvement. Nine QIs pertaining to the diagnosis and management of eosinophilic esophagitis (EoE) were recently established. We therefore aimed to identify existing gaps in care using these QIs. This is a retrospective, multicenter study utilizing recently established EoE QIs to evaluate practice patterns among adult gastroenterologists in the diagnosis and management of EoE. Three patient cohorts of 30 patients each presenting with dysphagia, food impaction, and new diagnosis of EoE, respectively, were obtained, yielding 120 patients per site to assess for every QI. Summary statistics were reported across two main themes: diagnosis and management. Subsequent analysis of gaps in care was then performed. The domain of diagnosis of EoE (QI 1 and 2) had the most notable gap in care with only 55% of the presenting patients undergoing appropriate evaluation for EoE. The domain of management of EoE had overall higher QI fulfillment-however it also contained significant intra-category variation in care. Notably, while 79% of patients had clinical follow-up within 1year from remission, only 54% underwent surveillance endoscopy within 2years of remission. In contrast, 100% of patients with symptomatic strictures independent of histologic response underwent endoscopic dilation (QI 4). Management approaches for EoE are evolving and variation in care delivery exists. We identified significant gaps in both diagnosis of EoE especially amongst patients presenting with index food impaction and long term management of EoE, when retrospectively evaluating care patterns using newly established QIs. This is the first study of its kind to utilize these previously established QIs to objectively identify care gaps that exist in EoE amongst several institutions. These findings also highlight the importance of QIs and standardization of management of complex chronic diseases like EoE to help bridge these gaps and provide a framework to measure adherence to these best practices.

Regional variation in length of stay for stroke inpatient rehabilitation in traditional Medicare and Medicare Advantage.

Regional variation in health care use threatens efficient and equitable resource allocation. Within the Medicare program, variation in care delivery may differ between centrally administered traditional Medicare (TM) and privately managed Medicare Advantage (MA) plans, which rely on different strategies to control care utilization. As MA enrollment grows, it is particularly important for program design and long-term health care equity to understand regional variation between TM and MA plans. This study examined regional variation in length of stay (LOS) for stroke inpatient rehabilitation between TM and MA plans in 2019 and how that changed in 2020, the first year of the COVID-19 pandemic. Results showed that MA plans had larger across-region variations than TM (SD = 0.26 vs 0.24 days; 11% relative difference). In 2020, across-region variation for MA further increased, but the trend for TM stayed relatively stable. Market competition among all inpatient rehabilitation facilities (IRFs) within a region was associated with a moderate increase in within-region variation of LOS (elasticity = 0.46). Policies reducing administrative variation across MA plans or increasing regional market competition among IRFs can mitigate regional variation in health care use.

OA06 Regional differences in work productivity in patients with early rheumatoid arthritis in England and Wales

Abstract Background/Aims Inflammatory arthritis including rheumatoid arthritis (RA) causes significant work disability. Rapid diagnosis and early intervention can reduce the impact of disease. We have previously shown significant regional variation in care delivery. In this study we aim to study regional variation in work outcomes in early RA in England and Wales. Methods We used data from the UK National Early Inflammatory Arthritis Audit between April 2018 and March 2023 to identify patients with early-onset RA in England and Wales. At diagnosis, clinicians collected information on demographics and disease activity. Participants were invited to complete work outcome questionnaires at baseline and 3 months. Our analysis was restricted to patients with work data available at 3 months. The primary outcome was discontinuation of work due to arthritis. Patient characteristics were tabulated by region. Regression models (adjusted for age and gender) examined the associations between work discontinuation and region. Clustered standard errors were estimated to account for within-Trust correlations. Sensitivity models further explored the effects of deprivation and treatment delay. Results A total of 3,730 patients with confirmed RA provided work data. Mean age was 67, 62.3% were female and 7.8% from minority ethnic backgrounds. 14% were current smokers and 55.6% had one or more comorbidities. Median baseline DAS28 was 5.2 (IQR: 4.2-6.1). 363/3730 (10%) had stopped work due to RA by 3 months. 534/3,730 (14%) stopped work for any reason. In regression analysis, significant regional differences were seen in the odds of stopping work due to RA. The Midlands was the largest regional contributor of data and was used as the reference group. Patients from Northwest England were most likely to stop work by 3 months (age- and gender-adjusted OR 1.59, [95% CI 1.13-2.25]) with Midlands patients least likely. Sensitivity analysis showed that deprivation and treatment delay only partially attenuate the association between region and work outcome (OR for Northwest 1.57 [1.06-2.33]). Conclusion There is evidence of regional variation in the impact of new onset RA on work participation. Our analyses suggest that the associations are only partly explained by regional differences in care delivery or deprivation. Other factors such as job type and access to occupational health support warrant further investigation. Disclosure E. Alveyn: Other; Educational support from UCB. M. Adas: None. I. Sahbudin: None. A. Boonen: None. K. Bechman: Honoraria; UCB, Vifor Pharma. M.D. Russell: Honoraria; Abbvie, BioGen, Lilly, Galapagos, Menarini. Other; Educational grants from Lilly, Janssen, Pfizer, UCB. D. Nagra: Honoraria; Abbvie, Galapagos, Lilly. Other; Educational support from UCB. S. Gallagher: None. E. Price: None. K. Walker-Bone: None. S. Norton: None. J. Galloway: Honoraria; AbbVie, Celgene, Chugai, Gilead, Janssen, Eli Lilly, Pfizer, Roche and UCB.

National study of NAFLD management identifies variation in delivery of care in the UK between 2019 to 2022

Non-alcoholic fatty liver disease (NAFLD) is associated with liver and cardiovascular morbidity and mortality. Recently published NAFLD Quality Standards include 11 key performance indicators (KPIs) of good clinical care. This national study, endorsed by British Association for the Study of the Liver (BASL) and British Society of Gastroenterology (BSG), aimed to benchmark NAFLD care in UK hospitals against these KPIs. This study included all new patients with NAFLD reviewed in the outpatient clinic in the months of March 2019 and March 2022. Participating UK hospitals self-registered for the study through BASL/BSG. KPI outcomes were compared using Fisher's exact or Chi-square tests. Data from 776 patients with NAFLD attending 34 hospitals (England [25], Scotland [four], Wales [three], Northern Ireland [two]) were collected. A total of 85.3% of hospitals reported established local liver disease assessment pathways, yet only 27.9% of patients with suspected NAFLD had non-invasive fibrosis assessment documented at the point of referral to secondary care. In secondary care, 79.1% of patients had fibrosis assessment. Assessment of cardiometabolic risk factors including obesity, type 2 diabetes, hypertension, and smoking were conducted in 73.2%, 33.0%, 19.3%, and 54.9% of all patients, respectively. There was limited documentation of diet (35.7%) and exercise advice (55.1%). Excluding those on statins, only 9.1% of patients with NAFLD at increased cardiovascular risk (T2DM and/or QRISK-3 >10%) had documented discussion of statin treatment. Significant KPI improvements from 2019 to 2022 were evident in use of non-invasive fibrosis assessment before secondary care referral, statin recommendations, and diet and exercise recommendations. This national study identified substantial variation in NAFLD management in the UK with clear areas for improvement, particularly fibrosis risk assessment before secondary care referral and management of associated cardiometabolic risk factors. This study identified significant variation in the management of NAFLD in the UK. Only 27.9% of patients with suspected NAFLD had non-invasive fibrosis assessment performed to identify those at greater risk of advanced liver disease before specialist referral. Greater emphasis is needed on the management of associated cardiometabolic risk factors in individuals with NAFLD. Hospitals with multidisciplinary NAFLD service provision had higher rates of fibrosis evaluation and assessment and management of cardiometabolic risk than hospitals without multidisciplinary services. Further work is needed to align guideline recommendations and real-world practice in NAFLD care.

Does recruiting patients to diabetes prevention programmes via primary care reinforce existing inequalities in care provision between general practices? A retrospective observational study

BackgroundPrimary care plays a crucial role in identifying patients’ needs and referring at-risk individuals to preventive services. However, well-established variations in care delivery may be replicated in this prevention activity.ObjectiveTo...

Improving the Detection, Assessment, Management and Prevention of Delirium in Hospices (the DAMPen-D study): protocol for a co-design and feasibility study of a flexible and scalable implementation strategy to deliver guideline-adherent delirium care

IntroductionDelirium is a complex condition in which altered mental state and cognition causes severe distress and poor clinical outcomes for patients and families, anxiety and stress for the health professionals...

Impact of a Standardized Emergency Department Pain Protocol for Children with Sickle Cell Disease

Background/Objective: Sickle cell disease (SCD) is a common heritable red blood cell disorder that transcends the lifespan. Abnormal sickle-shaped erythrocytes interfere with blood flow in small vessels resulting in vaso-occlusion. This vaso-occlusion leads to tissue ischemia and inflammation which causes severe pain and is commonly referred to as a vaso-occlusive crisis (VOC). VOC is the most common complication seen in SCD and accounts for the majority of Emergency Department (ED) visits and hospitalizations. The primary objective of this study was to evaluate if pain management of SCD in pediatric patients at our institution was in accordance with national and institutional pain management guidelines before and after implementation of a standardized pain management algorithm.
 Methods: We retrospectively analyzed electronic medical record (EMR) data at Riley Hospital for Children between June 2015-May 2018, as well as from January 2019-December 2019 from for all pediatric patients (0-21 years old) who presented to the Riley ED with a confirmed diagnosis of SCD and uncomplicated VOC. These timeframes represented pre and post implementation of a standardized pain management algorithm, which has been described separately. The data collected included time to first dose of analgesia, type and dose of analgesia, change in pain score, length of stay in the ED, and disposition (discharge or admission). Univariate analyses were used to compare data between encounters.
 Results: Prior to implementation, 186 patients were seen for a total of 504 encounters, the majority of whom were male (59%, p<0.001) and had Hb SS disease (67%, p<0.001). The mean length of an ER visit was approximately 5 hours (+/-113 minutes). The median pain score at presentation was 9 (0-10 scale), with an average of 23 minutes from check in to first documented pain score. However, 19% of patients had no initial pain score documented, which occurred more often if the patient’s initial analgesic was given orally (p<0.001). The mean time from ED check in to first dose of analgesia (PO, IV, IN) was 76 minutes. The mean time between pain scores and medication administration increased between subsequent doses. 70% of these encounters resulted in hospitalization, with an average LOS of 4.1 days. Analysis of data following implementation of a standardized pain management algorithm is ongoing.
 Conclusion: Acute pain episodes are the leading cause of ED visits and hospitalizations for those with SCD. Thus, to properly meet the needs of patients with SCD and improve their outcomes, there needs to be collaborative, standardized and SCD- specific clinical guidelines for ED providers to utilize. Pre-implementation of a standardized acute pain management algorithm, our institution was not meeting national guidelines for administration of analgesia and assessment of pain. Post-implementation results are currently under analysis.
 Impact and Implications: Patients with SCD experience longer wait times in the ED and significant bias and mistrust regarding pain concerns. Standardized clinical guidelines have the potential to improve care and decrease variation in care delivery. The results from our study can inform institutional and national policy makers on gaps that exist in pediatric SCD, so that research funding can be appropriately allocated.

CORR Insights®: Do Disparities in Wait Times to Operative Fixation for Pathologic Fractures of the Long Bones and 30-day Complications Exist Between Black and White Patients? A Study Using the NSQIP Database.

CORR Insights®: Do Disparities in Wait Times to Operative Fixation for Pathologic Fractures of the Long Bones and 30-day Complications Exist Between Black and White Patients? A Study Using the NSQIP Database.

EDITORIAL COMMENT

Operating rooms have an immense financial impact to their individual hospitals’ bottom line and therefore to the entire national health care system. In fact, surgical care is responsible for approximately one third of all health care spending in the United States (3). In our more cost conscious contemporary medical paradigm, maximizing operating room and perioperative efficiency is necessary to deliver high-quality, lower cost care. Reducing daily variation in care delivery also has the potential to improve clinical outcomes, decrease complications and provide down-stream cost containment for health systems.

AGA Institute Quality Measure Development for the Diagnosis and Management of COVID-19

AGA Institute Quality Measure Development for the Diagnosis and Management of COVID-19

Creating equitable healthcare quality and safety for children with intellectual disability in hospital

Children with intellectual disability are susceptible to poor experiences of care and treatment outcomes, and this may compound existing health inequities. Evidence to date indicates three priority areas that must be addressed in order to reduce these inequities in the safety and quality of care for children with intellectual disability. Firstly, we need reliable methods to identify children with intellectual disability so that healthcare organizations understand their needs. Secondly, we need to develop quality metrics that can assess care quality and unwarranted care variation for children with intellectual disability in hospital. Finally, for a comprehensive understanding of the safety and quality of care for these children, and how to improve, it is critical that healthcare organizations partner with parents/carers and enable children with intellectual disability to voice their experiences of care. Children with intellectual disability have higher healthcare utilization than their peers; yet, their voice is rarely sought to optimize the safety and quality of their healthcare experience. Patient experience narratives enhance our understanding of the genesis of adverse events. By addressing these priorities, children with intellectual disability will be identified, and health services will measure and understand the problematic and beneficial variations in care delivery and can then effectively partner with children and their parents/carers to address the inequities in care quality and create safer healthcare.

Ten minutes with James Mountford, Chief of Quality and Learning, NHS Nightingale Hospital London

![Graphic][1] ### Biography James Mountford is Director of Quality at the Royal Free London NHS Foundation Trust, which has a multiyear programme focused on embedding quality and value improvement into...

Transcatheter mitral valve repair for functional mitral regurgitation: Evaluating the evidence

ObjectivesTwo trials (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation Trial and Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation Trial) were published in 2018 evaluating the effectiveness and safety of transcatheter repair for patients with heart failure with significant functional mitral regurgitation, which yielded different results. This article reviews the strength of the evidence, differences in trial designs, ethical and implementation implications, and delineates future research needs to help guide the appropriate dissemination of transcatheter repair for functional patients with mitral regurgitation. MethodsThe National Heart, Lung, and Blood Institute convened a workshop of interdisciplinary experts to address these objectives. ResultsTranscatheter repair of functional mitral regurgitation can provide significant benefits in terms of heart failure hospitalizations, survival, and quality of life when appropriate heart failure candidates with moderate to severe or severe mitral regurgitation while on optimal guideline-directed medical therapy can be identified. Key ingredients for success are preoperative evaluation and management and postoperative care by an interdisciplinary heart team. ConclusionsGiven the discordance observed between trials, ongoing innovation in patient management, and potential expansion of indications for use, the evidence base must be expanded to optimize appropriate implementation of this complex therapy. This will require more complete capture of outcome data in real-world settings for all eligible candidates whether or not they receive this therapy. Inevitably, the indications for use of this therapy will expand, as will the devices and therapeutic approaches for this population, necessitating the study of comparative effectiveness through randomized trials or observational studies. Moreover, given the substantial variations in care delivery, conducting implementation research to delineate characteristics of the optimal care model would be of benefit.

Abstract 52: Case Reports of Short-Term Outcome Following Mechanical Thrombectomy for Childhood Stroke May Be Overly Optimistic

Background: Meta-analyses of case reports and case series of mechanical thrombectomy in childhood arterial ischemic stroke (AIS) suggest that mechanical thrombectomy is associated with good short-term outcomes in approximately three-quarters of children. Methods: Retrospective data on 38 children treated between 2010-2019 with mechanical thrombectomy for stroke were collected from former Thrombolysis in Pediatric Stroke (TIPS) sites. To minimize reporting bias, sites were required to report all patients ≤ 17 years treated with mechanical thrombectomy either at the study site or at an outside hospital prior to transfer. Short-term outcomes, defined as change in NIHSS prior to and following mechanical thrombectomy (MT), were compared with 85 children from case reports/case series published between 2010-2019. Results: The mean age of children from former TIPS sites was 11.9 years, 50% male, 34% treated with IV tPA prior to thrombectomy. The mean age of published cases was 10.4 years, 65% males, 19% treated with IV tPA prior to thrombectomy. Case reports had a wider distribution of before-MT NIHSS scores, and a steeper decrease in distributions of after-MT NIHSS scores than those from study sites within 24 hours of MT (Figure 1A; medians: 15 to 4 in published cases, 12 to 8 in cases from sites) and at discharge (Figure 1B; medians: 15 to 3 in published cases, 12 to 5 in cases from sites). Conclusion: Patients reported to former TIPS sites had discernably lower rates of good short-term outcomes compared with published case reports and case series, suggesting publication bias. Capturing key metrics of safety and effectiveness of MT in children with AIS, including variations in care delivery in actual practice, will be critical in the creation of evidence-based guidelines for acute management of pediatric AIS.

Pulmonary embolism response team implementation improves awareness and education among the house staff and faculty

A subset of high-risk pulmonary embolism (PE) patients requires advanced therapy beyond anticoagulation. Significant variation in delivery of care has led institutions to standardize their approach by developing Pulmonary Embolism Response Team (PERT). We sought to assess the impact of PERT implementation on house staff and faculty education. After implementation of PERT, we employed a targeted educational intervention aimed to improve PERT awareness, familiarity with treatment options, role of echocardiogram and Doppler ultrasound, and knowledge of acute PE risk stratification tools. We conducted an anonymous survey among the house staff and faculty before and after intervention to assess the impact of PERT implementation on educational objectives among clinicians. Initial and follow up samples included 115 and 109 responses. The samples were well represented across the subspecialties and all levels of training, as well as junior and senior faculty. Following the educational campaign, awareness of the program increased (72.2-92.6%, p < 0.01). Proportion of clinicians with reported comfort level of managing PE increased (82.4-90.8%, p = 0.07). Proportion of clinicians with self-reported comfort with explaining all available treatment modalities to patients increased (49.1-67.9%, p = 0.005). Proportions of responders who correctly identified the role of echocardiography in risk stratification of patients with known PE increased (73.9-84.4%, p = 0.07). Accurate clinical risk stratification of acute PE increased (60.2-73.8%, p = 0.03). The implementation of a targeted educational program at a tertiary care center increased awareness of PERT among house staff and faculty and improved physician's accuracy of clinical risk stratification and comfort level with management of acute PE.

Impact of a Service Line Management Model on Behavioral Health Care in the Military Health System.

Large health care systems are seeking to reduce variation in care delivery and improve outcomes. This column describes the U.S. Army health care system's transformation to a service line management model and the impact on behavioral health care between 2013 and 2017. An evaluation found a promising association between the service line model and greater use of standard outpatient clinical programs, more frequent engagement of patients with serious conditions, and less use of inpatient services. The observational nature of these preliminary findings does not permit causal inferences; however, the service line model may help health care systems reduce variation between geographically distinct care delivery locations and improve performance.

The Struggle Is Real: How Residents Learn to Provide High-Value, Cost-Conscious Care

Phenomenon: Rising healthcare expenditures threaten the accessibility and affordability of healthcare systems. Research has demonstrated that teaching (junior) physicians to deliver high-value, cost-conscious care can be effective when learning is situated in a supportive environment. This study aims to offer insight into how residents learn to provide high-value, cost-conscious care in the workplace and how the postgraduate training environment influences this learning. Approach: Six homogeneous focus groups were held between August 2015 and July 2016 with 36 residents from six residency programs (dermatology, n = 5; elderly care, n = 8; family medicine, n = 5; internal medicine, n = 6; orthopedic surgery, n = 6; surgery, n = 6). An iterative grounded theory approach was used to analyze the qualitative data. Findings: Influential factors in learning of high-value, cost-conscious care delivery operated on three levels: individual resident, training program, and the workplace. On the individual level, we discerned three types of beliefs regarding HV3C. At the training program level, perceived determinants of learning included resident–supervisor interactions, involvement in decision-making over time, and exposure to variation in care delivery. At the workplace level, learning depended on the availability of professional healthcare expertise and the presence of institutional policy. Insights: Residents struggle to seize high-value, cost-conscious care learning opportunities in the workplace setting. Both residency training programs and workplaces can contribute to creating these learning opportunities. An important starting point is being aware of the different personal beliefs of residents and the approaches to high-value, cost-conscious care on the level of the training program and workplace.

The Medical Resuscitation Committee: Interprofessional Program Development to Optimize Care for Critically Ill Medical Patients in an Academic Pediatric Emergency Department.

Provision of optimal care to critically ill patients in a pediatric emergency department is challenging. Specific challenges include the following: (a) patient presentations are highly variable, representing the full breadth of human disease and injury, and are often unannounced; (b) care team members have highly variable experience and skills and often few meaningful opportunities to practice care delivery as a team; (c) valid data collection, for quality assurance/improvement and clinical research, is limited when relying on traditional approaches such as medical record review or self-report; (d) specific patient presentations are relatively uncommon for individual providers, providing few opportunities to establish and refine the requisite knowledge and skill; and (e) unscientific or random variation in care delivery. In the current report, we describe our efforts for the last decade to address these challenges and optimize care delivery to critically ill patients in a pediatric emergency department. We specifically describe the grassroots development of an interprofessional medical resuscitation program. Key components of the program are as follows: (a) a database of all medical patients undergoing evaluation in the resuscitation suite, (b) peer review and education through video-based case review, (c) a program of emergency department in situ simulation, and (d) the development of cognitive aids for high-acuity, low-frequency medical emergencies.

Abstract P3-14-05: Accurately monitoring by specialist teams reduces the time between breast cancer screening and initial surgical treatment

Abstract Background Over 266,000 women are newly diagnosed with breast cancer every year in the United States, roughly 21% of women die of the disease annually.[1] Many studies have been conducted to evaluate how delays in diagnosis and treatment can result in adverse patient outcomes. Factors including tumor size and stage, socioeconomic status, race/ethnicity, and hospital size and capabilities have been shown to influence outcomes. Variation in care delivery and turnaround times can be reduced by accurately examining the patient care path from initial screening mammography to first surgical intervention. We have developed a process to optimize timeliness to initial surgical treatment. Methods The process starts with observing care delivery from diagnostic mammogram, biopsy, pathology tissue processing, diagnosis and lumpectomy or mastectomy. A team of process and clinical experts (Leica Biosystems) conducted observations to map out current care delivery processes. Standard national metrics for timeliness within the breast care pathway from the National Consortium of Breast Centers' was applied to the process map to understand national averages as well as best practices. Timeliness data on 5,571 patients from over 250 breast centers across the country from the NQMBC (National Quality Measures for Breast Centers) database was utilized to review time intervals and intradepartmental hand offs that impact progression through the breast care pathway. Six sigma, black belt specialists conduct analysis of current breast center processes, identifies specific sites for improvement, integrates their recommendations and completes the cycle by repeat monitoring of the entire process. Results Our specialists have reviewed average and ideal overall performance in timeliness to initial surgical treatment. Improvements may be expected from 22%-75% in timeliness to initial surgical treatment. Turnaround Time (Days) Mean*Best Practice**Time from screening to dx mammo6.04.9Time from dx mamo to bx5.94.1Time from bx to path report2.11.2Time from bx to first surgery22.616.9Total time from screening mammogram to first surgery36.627.1* Mean=average number of business days based on NQMBC data July-Dec. 2017** "Best Practice"=The 75th percentile based on data in NQMBC database July-Dec. 2017 Conclusion A process to impact the timeliness of care between screening mammography and initial surgical treatment has been developed. Standardized and monitored care delivery processes can result in better efficiency in breast cancer patient care delivery from between 22% - 75%. Using a detailed patient care pathway and black belt specialists to analyze processes, we expect to reduce turnaround times and optimize efficiency across the breast cancer patient's care pathway. © 2018 Devicor Medical Products, Inc., part of Leica Biosystems. All rights reserved. LEICA and the Leica logo are registered trademarks of Leica Microsystems IR GmbH. Other logos, product and/or company names might be trademarks of their respective owners. MDM# 18798 Rev 07/18 [1] Cancer Facts and Figures 2018; American Cancer Society Citation Format: Neff K, Kaufman CS. Accurately monitoring by specialist teams reduces the time between breast cancer screening and initial surgical treatment [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-14-05.