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www.ahrq.gov/sites/default/files/2024-01/gallagher2-report.pdf
January 01, 2024 - Final Progress Report: Using Team Simulation to Improve Error Disclosure to Patients and Safety Culture
AHRQ Grant Final Progress Report
Title of Project: Using Team Simulation to Improve Error Disclosure to Patients and Safety
Culture
Principal Investigator: Thomas H. Gallagher, MD
Co-Investigators: Sarah Shann…
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www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/medical-office/2020_MOSOPS_Part_I-rev0921.pdf
January 01, 2020 - Surveys on Patient Safety Culture (SOPS) Medical Office Survey: 2020 User Database Report Part I
Surveys on Patient Safety
CultureTM (SOPS®)
MEDICAL OFFICE SURVEY:
2020 USER DATABASE REPORT
PATIENT
SAFETY
[This page intentionally left blank]
Surveys on Patient Safety CultureTM (SOPS®)
Medical Office Surv…
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www.ahrq.gov/sops/about/faq/index.html
June 01, 2022 - Surveys on Patient Safety Culture® (SOPS®) Program Frequently Asked Questions
Search or browse for answers to questions about the AHRQ Surveys on Patient Safety Culture® (SOPS®) Program, surveys, supplemental item sets, and the SOPS Databases. Send additional questions to SafetyCultureSurveys@westat.com.
…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Carayon.pdf
January 01, 2004 - Observing Nurse Interaction with Infusion Pump Technologies
349
Observing Nurse Interaction with
Infusion Pump Technologies
Pascale Carayon, Tosha B. Wetterneck, Ann Schoofs Hundt,
Mustafa Ozkaynak, Prashant Ram, Joshua DeSilvey, Brian Hicks,
Tanita L. Robert, Myra Enloe, Rupa Sheth, Sade Sobande
Abstract…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Mohr.pdf
February 01, 2004 - Learning from Errors in Ambulatory Pediatrics
355
Learning from Errors in
Ambulatory Pediatrics
Julie J. Mohr, Carole M. Lannon, Kathleen A. Thoma, Donna Woods,
Eric J. Slora, Richard C. Wasserman, Lynne Uhring
Abstract
Background: Approximately 70 percent of pediatric care occurs in ambulatory
settings, …
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Encinosa.pdf
January 01, 2003 - What Happens After a Patient Safety Event? Medical Expenditures and Outcomes in Medicare
423
What Happens After a Patient Safety Event?
Medical Expenditures and Outcomes
in Medicare
William E. Encinosa, Fred J. Hellinger
Abstract
Objective: To estimate the impact of potentially preventable adverse event…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Croskerry.pdf
January 01, 2004 - Diagnostic Failure: A Cognitive and Affective Approach
241
Diagnostic Failure: A Cognitive
and Affective Approach
Pat Croskerry
Abstract
Diagnosis is the foundation of medicine. Effective treatment cannot begin until an
accurate diagnosis has been made. Diagnostic reasoning is a critical aspect of
clinic…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Harris.pdf
June 30, 2004 - Mixed Methods Analysis of Medical Error Event Reports: A Report from the ASIPS Collaborative
133
Mixed Methods Analysis of Medical
Error Event Reports: A Report from
the ASIPS Collaborative
Daniel M. Harris, John M. Westfall, Douglas H. Fernald,
Christine W. Duclos, David R. West, Linda Niebauer,
Linda Ma…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Kravitz.pdf
February 09, 2005 - From Insight to Implementation: Lessons from a Multi-site Trial of a PDA-based Warfarin Dose Calculator
395
From Insight to Implementation:
Lessons from a Multi-site Trial of
a PDA-based Warfarin Dose Calculator
Richard L. Kravitz, Jonathan D. Neufeld, Michael A. Hogarth,
Debora A. Paterniti, William Dager, …
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Comden.pdf
January 01, 2003 - Using Probabilistic Risk Assessment to Model Medication System Failures in Long-term Care Facilities
395
Using Probabilistic Risk Assessment
to Model Medication System Failures
in Long-term Care Facilities
Sharon Conrow Comden, David Marx, Margaret Murphy-Carley, Misti Hale
Abstract
Objectives: State agenc…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Tuinen.pdf
March 01, 2004 - Surveillance of Surgery-related Adverse Events in Missouri Using ICD-9-CM Codes
245
Surveillance of Surgery-related Adverse
Events in Missouri Using ICD-9-CM Codes
Mark Van Tuinen, Susan Elder, Carolyn Link, Susan Li,
John H. Song, Tracey Pritchett
Abstract
Objectives: This study estimated the validity of 2…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Grayson.pdf
January 01, 2003 - Do Transient Working Conditions Trigger Medical Errors?
53
Do Transient Working Conditions
Trigger Medical Errors?
Deborah Grayson, Stuart Boxerman, Patricia Potter, Laurie Wolf,
Clay Dunagan, Gary Sorock, Bradley Evanoff
Abstract
Objective: Organizational factors affecting working conditions for health …
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www.ahrq.gov/sites/default/files/wysiwyg/research/findings/evidence-based-reports/services/quality/patientsftyupdate/ptsafetysum.pdf
March 01, 2013 - Making Health Care Safer II, Executive Summary
Evidence-Based
Practice
Evidence-based Practice
Program
The Agency for Healthcare Research and
Quality (AHRQ), through its Evidence-
based Practice Centers (EPCs), sponsors
the development of evidence reports and
technology assessments to assist public-
and priv…
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www.ahrq.gov/research/findings/final-reports/ssi/ssiapa.html
April 01, 2018 - Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection
Appendix A. Teleconferences with AHRQ & CDC
Previous Page Next Page
Table of Contents
Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection
Executive Summary
Chapter 1.…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy4/Strat4_Tool_4_PPT_508.pptx
April 01, 2011 - Strategy 4: IDEA Discharge Planning (Tool 4)
Insert hospital logo here
Care Transitions from Hospital to Home: IDEAL Discharge Planning Training
[Hospital Name | Presenter name and title | Date of presentation]
Strategy 4: IDEAL Discharge Planning (Tool 4)
Guide to Patient & Family Engagement
If you have condu…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/intro-dailycare-facguide.docx
January 01, 2017 - Facilitator Guide: Build Your SSI Prevention Bundle
Slide Title and Commentary
Slide Number and Slide
Title Slide
Introduction to Daily Care Processes: Evidence Behind Spontaneous Awakening Trials, Spontaneous Breathing Trials, and Head of Bed Elevation
SAY:
In this module, you will be introduced to daily care pr…
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www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/tools-and-materials/60-tenn-health-coach-sustainability-plan-toolkit.pdf
June 02, 2025 - Health Coach Intervention Sustainability Plan
Health Coach Intervention Sustainability Plan
Medicare Preventative Services
i. In Office Visits, Modifiers and Add-On Codes
a. Annual Wellness Visits
1. Medicare
i. Description-Initial Preventative Physical Exam (IPPE) also known as
“Welcome to Medicare” visit
ii. …
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www.ahrq.gov/sites/default/files/2024-01/zabar-report.pdf
January 01, 2024 - Final Progress Report: Safe delivery of primary care to vulnerable populations: Using simulation to assess team performance in responding to behavioral and social determinants of health
AHRQ Grant Final Progress Report
Title of Project
Safe delivery of primary care to vulnerable populations: Using simulation (Unanno…
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/2024-virtual-research-meeting-summary-prems-proms.pdf
January 01, 2024 - CAHPS 2024 Research Meeting Summary
Consumer Assessment of Healthcare Providers and Systems
(CAHPS®)
2024 Research Meeting Summary
Patient-Reported Experience and Outcome
Measures (PREMs and PROMs) in
Research and Clinical Practice
November 2024
2
Table of Contents
Introduction ......................…
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www.ahrq.gov/sites/default/files/2025-04/elder-report.pdf
January 01, 2025 - Final Progress Report: Patient Safety and the Primary Care Testing Process
Final Report
1. Title page
Patient Safety and the Primary Care Testing Process
PI: Nancy C. Elder, MD, MSPH
Department of Family and Community Medicine
University of Cincinnati
PO Box 670582
3235 Eden Ave, 142 HPB
Cincinnati, OH 45267…