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  1. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/frontline-cases-studies.pdf
    May 01, 2015 - something that I just knew was going to be the best thing for our unit and our patients, so I made it happen
  2. www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/tools/PCMH/pcpf-module-5-working-with-safety-net-practices.pdf
    September 01, 2015 - visit, immunizations, lab work, behavioral health discussions, goal setting with the case manager—all happen
  3. www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-teamwork-leadership.pdf
    April 30, 2025 - It also indicates that culture change to shift such dynamics can happen but takes time, training, and
  4. www.ahrq.gov/sites/default/files/2025-03/taylor-report.pdf
    January 01, 2025 - Final Progress Report: Disseminating a Web-Enabled Safety Risk Assessment (SRA) Toolkit for Designing Safer Healthcare Facilities Final Report 1. Title Page Principal Investigator: Ellen Taylor Project Title: Disseminating a web-enabled Safety Risk Assessment (SRA) toolkit for designing safer healthcare facilitie…
  5. www.ahrq.gov/sites/default/files/2024-11/gregory-report.pdf
    January 01, 2024 - Final Progress Report: What About Mom? Using Administrative Data To Develop Measures for Monitoring Healthcare Quality in Pregnancy & Childbirth 1 AHRQ Final Progress Report Title: What about mom? Using Administrative Data to Develop Measures for Monitoring Healthcare Quality in Pregnancy & Childbirth Principal In…
  6. www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-case4.html
    November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies Case 4. Suntown Hospital Previous Page Next Page Table of Contents Improving Care Delivery Through Lean: Implementation Case Studies Introduction to the Case Studies Case 1. Lakeview Healthcare Case 2. Central Hospital Case 3.…
  7. www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/AHRQ-Hospital-Survey-2.0-Users-Guide-5.26.2021.pdf
    January 01, 2021 - AHRQ Hospital Survey 2.0 User's Guide PATIENT SAFETY HOSPITAL SURVEY ON PATIENT SAFETY CULTURE VERSION 2.0 USER'S GUIDE AHRQ Hospital Survey on Patient Safety Culture Version 2.0: User’s Guide Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fisher…
  8. www.ahrq.gov/sites/default/files/2024-04/koss-report.pdf
    January 01, 2024 - Grant Final Report: Toward an Optimal Patient Safety Information System (TOPSIS) Grant Final Report Grant ID: R01HS015164 Toward an Optimal Patient Safety Information System (TOPSIS) Inclusive Dates: 09/30/04 - 03/31/08 Principal Investigator: Richard Koss, MA Team Members: Stacey…
  9. www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/nursing-home/nursinghome-users-guide.pdf
    April 01, 2022 - AHRQ Nursing Home Survey on Patient Safety Culture: User’s Guide NURSING HOME SURVEY ON PATIENT SAFETY CULTURE: USER’S GUIDE PATIENT SAFETY AHRQ Nursing Home Survey on Patient Safety Culture: User’s Guide Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services…
  10. www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-200-fullreport.pdf
    November 01, 2017 - Appropriateness of Red Cell Transfusions in the Pediatric Intensive Care Unit Appropriateness of Red Cell Transfusions in the Pediatric Intensive Care Unit Section 1. Basic Measure Information 1.A. Measure Name Appropriateness of Red Cell Transfusions 1.B. Measure Number 0200 1.C. Measure Description Plea…
  11. www.ahrq.gov/sites/default/files/2024-02/gurses-report.pdf
    January 01, 2024 - Final Progress Report: Patient-Centric Risk Model for Medication Safety During Care Transitions Final Progress Report of “Patient-Centric Risk Model for Medication Safety During Care Transitions” 1. TITLE PAGE Project Title: Patient-Centric Risk Model for Medication Safety During Care Transitions Principal Investi…
  12. www.ahrq.gov/sites/default/files/wysiwyg/pcor/pcortf-strategic-framework.pdf
    June 01, 2023 - Patient-Centered Outcomes Research Trust Fund Strategic Framework Patient-Centered Outcomes Research Trust Fund Strategic Framework National Health Priorities Patient-Centered Outcomes Research S…
  13. www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/hospitals/red-toolkit/redtoolkitforms.pdf
    September 01, 2012 - Re-Engineered Discharge Toolkit 1 Re-Engineered Discharge Toolkit Samples and Forms 1 Sample After Hospital Care Plan (AHCP) 2 **Bring This Plan to ALL Appointments** After Hospital Care Plan for: Oscar Sanchez Discharge Date: August 1, 2012 TRY TO QUIT SMOKING: Call Jon Doe at (555)…
  14. www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/npsd-chartbook-2019.pdf
    January 01, 2019 - nine patient safety event types that represent the majority of reported preventable injuries that happen … pertain to nine patient safety events that represent the great majority of preventable injuries that happen
  15. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/sppc-summary_report.pdf
    May 01, 2017 - allow sufficient time for units to fully implement all three program pillars and for culture change to happen
  16. www.ahrq.gov/sites/default/files/2024-01/higginson-report.pdf
    January 01, 2024 - Denominators may be for periods ranging from a month (to capture frequent events) to a year (for events that happen
  17. www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/resources/final-rapid-cycle-research-guidance.pdf
    June 01, 2015 - Using Rapid-Cycle Research to Reach Goals: Awareness, Assessment, Adaptation, Acceleration  Using Rapid-Cycle Research to Reach Goals: Awareness, Assessment, Adaptation, Acceleration Using Rapid-Cycle Research to Reach Goals: Awareness, Assessment, Adaptation, Acceleration P…
  18. www.ahrq.gov/sites/default/files/wysiwyg/research/findings/final-reports/stpra/stpra.pdf
    March 01, 2012 - If this does not happen, further data would need to be collected (e.g., through additional interviews
  19. www.ahrq.gov/data/apcd/envscan/findings.html
    July 01, 2022 - Crossing State lines for care may happen more often in small States with limited provider workforces
  20. www.ahrq.gov/sites/default/files/2024-01/cohen-report.pdf
    January 01, 2024 - But the alternative to ST-PRA is to assume the system is safe, wait for events to happen, investigate

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