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www.ahrq.gov/sites/default/files/wysiwyg/news/events/ahrq-research-summit/schiff-summit2016.pdf
January 01, 2013 - cases
Schiff Arch Intern Med 2009
What went wrong: DEER Taxonomy Localization
8
Art Elstein
Cognitive … negative mammogram and/or ultrasound
• Atypical presentation
• Addison’s disease presenting with cognitive
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www.ahrq.gov/news/newsroom/case-studies/202301.html
October 01, 2024 - Those at highest risk for hypoglycemia are patients over 75 years old with dementia or cognitive impairment
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www.ahrq.gov/sites/default/files/2024-11/blumenthal-report.pdf
January 01, 2024 - In
addition, the survey underwent cognitive testing within the focus groups. … Ten EDs served as sites for psychometric testing. … The survey collected perceptions
about all the domains identified in psychometric testing, including … The 10 psychometric survey testing sites reviewed charts for patients who
presented to the ED during … In testing all
hypotheses and study questions, we are interested in institution-level inferences and
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www.ahrq.gov/sites/default/files/2024-04/bonardi-report.pdf
January 01, 2024 - Words: intellectual disability, fall prevention
Purpose
This study was designed as a first step in testing … and prevent falls in the
general population of older adults may differ for adults with ID because of cognitive … Boulder, CO: Department of Psychiatry and Coleman
Institute for Cognitive Disabilities University of
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www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/04-new_sops_diagnostic_safety-yount.pdf
October 20, 2021 - or groups of items assessing specific
areas of diagnostic safety:
► Time Availability (3 items)
► Testing … ” (NA/DK) or missing (MI) responses.
49
Composite Measure Results
Average % Positive Response
Testing … 67
50
Testing … office finish their patient notes by the
end of their regular workday.
54
Open-ended Comments
Testing … Fall 2020 Pilot Study
Participating Medical Offices
Results
Composite Measure Results
Testing and
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/nicu_toolkit/nicupacket-apb.pdf
June 02, 2025 - ■ Post-discharge social and environmental conditions significantly influence cognitive outcome. … Testing
■ Adjust an infant’s age for prematurity until he/she is 2 years adjusted age. … ■ Err on the side of caution, and refer the infant for formal testing early rather than waiting. … Outcomes
Poor head growth by 8 months corrected age is a strong predictor of poor cognitive function, … Sleep Patterns and Cognitive Development
■ Development of sleep-wake cycles likely has major impact
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Perry_49.pdf
March 27, 2008 - record (discoverable
following an unintended outcome), or are handoff forms and checklists merely cognitive … This also undermines workers’ macro-
cognitive functions (i.e., problem recognition, analysis, sensemaking … The use
of written and electronic cognitive artifacts has shown benefit within specific clinical care … Joint cognitive systems:
Patterns in cognitive systems engineering. … How unexpected events
produce an escalation of cognitive and coordinative
demand.
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-088-fullreport.pdf
January 05, 2017 - Manual Chart Abstraction of the Measures
Testing Sites
The testing sites for the testing of this measure … Access in many areas is also limited to psychologists when further assessment of cognitive
issues is … The testing was completed within the CPQSC, a testing network that comprises Chicago-area
hospitals … Three hospitals were able to participate in the testing, and results of the testing included two of … Access in many areas is also limited to psychologists
when further assessment of cognitive issues is
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Karsh.pdf
April 22, 2004 - technology to suit their needs using two
methods: making the system compatible with their current cognitive … .34 used a sociotechnical system analysis to analyze and improve the safety of
outpatient diagnostic testing … Once completed, pilot testing and implementation can
begin. … Usability testing
in medical informatics: cognitive approaches to
evaluation of information systems … Hazard-control matrix: example of one hypothetical hazard in the diagnostic testing process
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www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hsops2.0-webcast-transcript.pdf
January 01, 2020 - acknowledge the Westat research team members listed here who were involved with the
development pilot testing … https://www.ahrq.gov/sops/index.html 5
Sorra, Slide 26
What were the goals of HSOPS 2.0 pilot testing … We further edited item wording and
developed new survey items, and we conducted more cognitive testing
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/facilities/ltc/gdmod1a.html
October 01, 2014 - Perform a general exam; assess level of consciousness and cognitive and physical function.
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www.ahrq.gov/news/newsletters/e-newsletter/943.html
January 01, 2025 - Cognitive biases and artificial intelligence . … Testing and masking policies and hospital-onset respiratory viral infections.
-
www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/110-ss-lfd-sample.docx
April 01, 2025 - policy
· Training and education
· Additional study or analysis
Intermediate Actions
· Checklists or cognitive … or remove unnecessary steps
· Standardize equipment and process of care map
· New device usability testing … Pre-op, he was seen in the clinic and completed all labs and testing to be cleared for surgery.
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/preventive/chipra-202-fullreport.pdf
January 01, 2014 - following domains must be included in the standardized
developmental screening tool: motor, language, cognitive … developmental screening tools enable providers to screen across several developmental
domains: language, cognitive … Sites
The testing sites for reliability testing through manual chart abstraction of this measure included … eMeasure Testing
Testing Sites
Based on feasibility testing (See Section 8 for more detail), Children … Measure Testing
Feasibility.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/OConnor.pdf
January 01, 2003 - model of
clinical inertia that takes into account recent developments in human factors
research, cognitive … Cognitive interventions targeting
specific decision pathologies
Diagnostic tools that assess a given … a similar rudimentary decision support delivered through an
EMR system increased frequency of A1c testing … levels, more specific and tailored
decision support based on and tailored to specific physicians’ cognitive … Distributed
decision making: cognitive models for cooperative
work.
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www.ahrq.gov/prevention/guidelines/tobacco/clinicians/references/meta/meta02.html
October 01, 2014 - randomized trial of a self-help smoking cessation intervention in a nonvolunteer female population: testing … randomized trial of a self-help smoking cessation intervention in a nonvolunteer female population: testing … randomized trial of a self-help smoking cessation intervention in a nonvolunteer female population: testing … Cognitive-behavioral intervention increases abstinence rates for depressive-history smokers. … Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking.
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www.ahrq.gov/hai/tools/surgery/tools/applying-cusp/learn-from-defects.html
December 01, 2017 - Checklists or cognitive aid.
Increased staffing or reduced workload.
Redundancy. … New device usability testing before purchasing. … Checklists or cognitive aid.
Increased staffing or reduced workload.
Redundancy. … New device usability testing before purchasing.
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/perinatal/chipra-0085-fullreport.pdf
December 31, 2015 - Studies have shown that untreated maternal depression
negatively affects an infant's cognitive, neurologic … testing was conducted. … (See Measure
Testing Protocol for PCPI Performance Measures, ama-assn.org/resources/doc/cqi/pcpi-testing … testing was conducted. … (See
Measure Testing Protocol for PCPI Performance Measures, ama-assn.org/resources/doc/cqi/pcpi-
testing-protocol.pdf
-
www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/labor-delivery-unit/ldu-safety-slides.html
July 01, 2023 - Checklists are cognitive aids that—
Reduce slips that occur due to lapses in concentration, distractions … Use of cognitive aids, such as checklists.
Communication with rapid responders. … Use of cognitive aids.
Communication with rapid responders. … Cognitive aids such as checklists, algorithms, or protocols, may improve team response to cord prolapse … Use of cognitive aids.
Communication with rapid responders.
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www.ahrq.gov/sites/default/files/2025-02/woods2-report.pdf
January 01, 2025 - Diagnostics (medical history and physical examination, diagnostic testing, reading,
recording, and … Vigilance
It is important to remember that the resulting safety interventions will require further testing … For example, the lack of
pediatric knowledge in the assessment of acuity of a pediatric patient is a cognitive … Grouping Process steps across different FMEA Topics
16
Lab Testing and
Diagnostics … PSO representative cases,
develop safety interventions that could then be tested and supported (if testing