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4061. Strengthening the Business Case for Patient Safety | PSNet
      psnet.ahrq.gov/perspective/strengthening-business-case-patient-safety
      May 01, 2013 - the adoption of evidence-based guidelines, including catheter-associated urinary tract infections and falls … from Medicare's Inpatient Quality Reporting (IQR) program, including process measures focused on the prevention … In 2014, the program will expand to include the prevention of catheter-associated urinary tract infection … The impact of computerized physician order entry on medication error prevention.

4062. DHR Impact and Reach | Digital Healthcare Research
      digital.ahrq.gov/program-overview/research-reports/2023-year-review/dhr-impact-reach
      January 01, 2023 - Across Patients’ Hospital Stays Development and Usability Testing of an Exercise-Based Primary Care Fall Prevention

4063. Final Progress Report: National Trends in Outpatient Quality Indicators (pdf file)
      www.ahrq.gov/sites/default/files/2024-11/stafford-fortmann-report.pdf
      January 01, 2024 - Are evidence-based cardiovascular prevention therapies being used? … Prevention and Control 2005;1:285-295. Ma J, Lee K-V, Stafford RS. … Specialty differences in cardiovascular disease prevention practices. … Are evidence-based cardiovascular prevention therapies being used? … Prevention and Control 2005;1:285-295. Ma J, Lee K-V, Stafford RS.

4064. A Sleep Promotion Toolkit for Hospitalized Patients - Final Report (pdf file)
      digital.ahrq.gov/sites/default/files/docs/citation/r21hs024330-ye-final-report-2018.pdf
      January 01, 2018 - sleep disturbance has been linked to clinically relevant and detrimental outcomes such as delirium and falls … sleep, have been linked to clinically relevant and detrimental outcomes such as delirium [8,9] and falls … common, even in older patients in spite of a warning of high risk of side effects including delirium and falls … cognitive function (measured by the PROMIS tools), use of pharmacological sleep aid, incidence of falls … pharmacological sleep aid Medical record At discharge Delirium Medical record At discharge Falls

4065. Disposition of Comments: Technical Brief 37 Prevention, Diagnosis, and Management of Opioids, Opioid Misuse, and Opioid Use Disorder in Older Adults (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/tech-brief-37-opiod-use-adults-comments.pdf
      November 03, 2020 - Disposition of Comments: Technical Brief 37 Prevention, Diagnosis, and Management of Opioids, Opioid … in Older Adults Technical Brief Disposition of Comments Report Research Review Title: Prevention … Other factors such as drug interactions, falls, depression, osteoporosis would likely be bigger issues … We appreciate this comment, and also agree that drug interactions, falls, depression, and osteoporosis … More emphasis on harms such as falls, cognitive impairment, osteoporosis, dependency, depression is

4066. Module 6: Sustainability | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module6/mod6-slides.html
      March 01, 2017 - Tool 6A: Sustainability Tool: Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care

4067. CHIPRA - Spotlight on New Mexico (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/nm-statesum.pdf
      July 01, 2015 - CHIPRA - Spotlight on New Mexico July 2015 This brief highlights the major strategies, lessons learned, and outcomes from New Mexico’s experience in the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children’s Health Insurance Program Reauthorization Act of 2009 (…

4068. Primary Care Extension in Oklahoma: An Evidence-Based Approach to Dissemination and Implementation of Innovations | Agency for Healthcare Research and Quality
      www.ahrq.gov/ncepcr/research-transform-primary-care/transform/impactgrants/impact-profile-ok.html
      April 01, 2015 - Primary Care Extension in Oklahoma: An Evidence-Based Approach to Dissemination and Implementation of Innovations AHRQ Estimating the Costs of Supporting Primary Care Transformation Grants Principal Investigator: James W. Mold, MD, MPH Institution: University of Oklahoma Health Sciences Center, …

4069. Primary Care Extension in Oklahoma: An Evidence-Based Approach to Dissemination and Implementation of Innovations (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/tpc/impact-profile-ok.pdf
      April 01, 2015 - Primary Care Extension in Oklahoma: An Evidence-Based Approach to Dissemination and Implementation of Innovations Primary Care Extension in Oklahoma: An Evidence-Based Approach to Dissemination and Implementation of Innovations Principal Investigator: James W. Mold, MD, MPH Institution: University of …

4070. Infectious Disease Including HIV/AIDS #09 (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/infectiousdisease_hi_impact.pdf
      December 01, 2013 - *Emtricitabine/tenofovir (Truvada) for prevention of HIV infection 5. … HIV prevention measures remain a crucial pillar in controlling the disease. … incorporating it into HIV primary care practice is feasible. 58 Current approach to care Anal cancer falls … Doctors to FDA: "HIV prevention pill" not ready for approval. [internet]. … Centers for Disease Control and Prevention (CDC).

4071. Archived: Physical Activity: Behavior Counseling in Primary Care, July 2002 | United States Preventive Services Taskforce
      www.uspreventiveservicestaskforce.org/uspstf/recommendation/physical-activity-behavioral-counseling-primary-care-2002
      July 01, 2002 - Adults: Behavioral Interventions (2018) Healthy Diet and Physical Activity for Cardiovascular Disease Prevention … (Associate Professor, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard … Washington, DC: Office of Disease Prevention and Health Promotion; 1996. 2. … Department of Health and Human Services, Centers for Disease Control and Prevention. … National Center for Chronic Disease Prevention and Health Promotion; 1996.

4072. NAA Data Tools – National Healthcare Safety Dashboard
      datatools.ahrq.gov/action-alliance/
      June 30, 2024 - two or more of the same AE for the same patient during a single hospitalization (e.g., two or more falls … inpatient locations and instructions for mapping can be found in the Centers for Disease Control and Prevention … for example, all March data should be entered by April 30), to have the greatest impact on infection prevention … for example, all March data should be entered by April 30), to have the greatest impact on infection prevention

4073. In Conversation With… Gregg S. Meyer, MD, MSc | PSNet
      psnet.ahrq.gov/perspective/conversation-gregg-s-meyer-md-msc
      June 01, 2016 - analysis, which provide a thorough, well-rounded review of patient safety concepts needed for harm prevention … When a patient falls victim to a medication error, the employees may experience heightened emotions and … Neonatal heparin overdose-a multidisciplinary team approach to medication error prevention. … Interview In Conversation with Edwin Boudreaux about Suicide Prevention

4074. Getting Started Laying the Groundwork Coordination for Implementing Automatic Referral & Effective Care
      www.ahrq.gov/sites/default/files/wysiwyg/takeheart/training/getting-started-slides.pptx
      December 31, 2022 - Circulation. 2010 Jan 5;121(1):63-70 Centers for Disease Control and Prevention: Million Hearts. … Citations from this slide: Centers for Disease Control and Prevention. … AHA/AACVPR Scientific Statement: Core Components of Cardiac Rehabilitation/ Secondary Prevention Programs … Journal of Cardiopulmonary Rehabilitation and Prevention. 2007;27:121/129 Ritchey et al.

4075. In Conversation with Jessica Behrhorst about The Evolution of Root Cause Analysis | PSNet
      psnet.ahrq.gov/perspective/conversation-jessica-behrhorst-about-evolution-root-cause-analysis
      February 26, 2025 - We have individuals going out into individual homes, where some serious events occur, like patient falls … to examine patterns across multiple events within a category (such as medication errors or patient falls … Root Cause Analysis and Medical Error Prevention. StatPearls Publishing; 2024.

4076. The Evolution of Root Cause Analysis | PSNet
      psnet.ahrq.gov/perspective/evolution-root-cause-analysis
      February 26, 2025 - to examine patterns across multiple events within a category (such as medication errors or patient falls … Root Cause Analysis and Medical Error Prevention. StatPearls Publishing; 2024. … We have individuals going out into individual homes, where some serious events occur, like patient falls

4077. From Quality Measures to Quality Care: Examples of Quality Improvement at Work | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/quality-measures/21st-century/challenges.html
      June 01, 2018 - Among these are: The Prevention of Heart Attacks with Beta-Blocker Treatment Despite the clear medical … In 1989, the National Institutes of Health initiated the National Asthma Education and Prevention Program … Under a 4-year program, the Centers for Disease Control and Prevention (CDC) and the Health Care Financing … HCFA is working with its Peer Review Organizations (PROs), the Centers for Disease Control and Prevention … Care Policy and Research has published two clinical practice guidelines addressing the prediction, prevention

4078. A Patient Safety Program & Research Evaluation of U.S. Navy Pharmacy Refill Clinics (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Reige.pdf
      March 01, 2004 - Elderly people are at a higher risk for falls resulting in serious injury, and when a person is dizzy … When an elderly patient falls, serious injury may occur.

4079. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49769/psn-pdf
      September 01, 2016 - Complaints as Safety Surveillance September 1, 2016 Morris JL, Bismark M. Complaints as Safety Surveillance. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/complaints-safety-surveillance The Case A 42-year-old woman presented to the emergency department with abdominal pain. She said the pain came on sudden…

4080. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49625/psn-pdf
      May 01, 2011 - Pocket Syringe Swap May 1, 2011 Kulli JC. Pocket Syringe Swap. PSNet [internet]. 2011. https://psnet.ahrq.gov/web-mm/pocket-syringe-swap The Case A 58-year-old man, scheduled for aortoiliac artery bypass graft, had an epidural catheter placed for postoperative pain management. Surgery proceeded uneventfully under…