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effectivehealthcare.ahrq.gov/sites/default/files/pdf/disabilities-quality-improvement-outcomes_research-protocol.pdf
August 03, 2011 - This review will examine how the outcomes of health care for people with disabilities are
assessed. … These quality indicators do
not address considerations relating to disability.”
4
For example, the … It represents a step in helping to create a more systematic taxonomy for
discussing these issues and … Technical Experts do not do
analysis of any kind nor contribute to the writing of the report and have … not reviewed the report,
except as given the opportunity to do so through the peer review or public
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psnet.ahrq.gov/perspective/conversation-libby-hoy-and-stephen-hoy
March 10, 2021 - LH : Sure, to do that I’ll level set a little bit with how we're approaching the different terms that … KH : One of the challenges, it seems, is that you're trying to do this work in a system that's already … If we want to create an equitable health system, how do we build in the infrastructure for engagement … KH : How do you know when you have authentic PFE? … How do you show that?
LH : That’s the million-dollar question.
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www.uspreventiveservicestaskforce.org/home/getfilebytoken/MjwZ4vRLZDVUSnfMA6SrDo
June 01, 2012 - Clinicians could inquire
about abuse during the clinic visit if there were indications
to do so. … For women identified through screening with current, past,
or increased risk for IPV, how well do interventions … well do
interventions reduce exposure to IPV, physical or mental harms, or mortality? … How well
the results of studies translate to clinical practice is also not
clear, although most studies … For women identified through screening with current, past, or increased risk for IPV, how well do interventions
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effectivehealthcare.ahrq.gov/sites/default/files/related_files/medical-test-reviews-genetic.ppt
June 01, 2012 - If appropriate, how is confirmatory testing performed to resolve false positive
results in a timely … How often does the test fail to give a usable result?
17. … How were samples obtained?
How were samples handled and stored prior to analysis? … How to use an article about genetic association: A: Background concepts. … How to use an article about genetic association: A: Background concepts.
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effectivehealthcare.ahrq.gov/sites/default/files/medical-test-reviews-genetic.ppt
June 01, 2012 - If appropriate, how is confirmatory testing performed to resolve false positive
results in a timely … How often does the test fail to give a usable result?
17. … How were samples obtained?
How were samples handled and stored prior to analysis? … How to use an article about genetic association: A: Background concepts. … How to use an article about genetic association: A: Background concepts.
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www.ahrq.gov/sites/default/files/2024-01/bolton-report.pdf
January 01, 2024 - This allows us to determine when and how reserved alarm
sounds can mask other reserved alarms and to … failures has to do with simultaneous masking, a condition in which concurrent
sounds interact in ways … Case studies will be
used to show that the method supports its intended design goals. … synthetic case studies based on the parameters of IEC 60601-1-8. … The method improvements are responsible for the performance observed in synthetic case
studies used
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www.ahrq.gov/hai/cauti-tools/guides/implguide-pt3.html
October 01, 2015 - A catheter may be needed when nurses do not have resources such as lift teams and mechanical lifts to … Providing patients and family members with educational materials on how to document the urine output … Product representatives can provide staff with guidance and instruction on how to use their devices correctly … When a urine culture is positive in a catheterized patient who has no symptoms of infection, do not treat … Skin Care in the Incontinent Patient
Educate caregivers on how to prevent skin breakdown in incontinent
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psnet.ahrq.gov/clinical-areas
March 24, 2025 - Miscommunication is a major contributor to adverse events. … to a patient safety incident. … Commentary
Doing 'detective work' to find a cancer: how are non-specific symptom … This scoping review explored how decision fatigue impacts decision-making in inpatient settings. … Commentary
How unprofessional behaviours between healthcare staff threaten patient
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hcup-us.ahrq.gov/reports/methods/2008_02.pdf
January 01, 2008 - could not do multivariate analyses and that we need to qualify many
conclusions. … That is, by looking at each factor individually, we do not
understand how they work together. … how care is provided and whether complications
occur—that help to explain variation in PSIs. … To demonstrate how the interpretation of the analysis results is further complicated, the same two
factors … States
and facilities should continue to look at how care is being delivered in hospitals and what
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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-Webster_76.pdf
July 18, 2008 - This is not rocket
science, and most ambulatory staff members already do meet to solve problems. … This process is easy to do but requires some discipline. … While these are admirable goals, how does a clinic or office begin to apply
the strategies and tools … How doctors think. Boston: Houghton
Mifflin Company; 2007.
12. Croskerry P. … How to
turn a team of experts into an expert medical team:
Guidance from the aviation and military
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-208-fullreport.pdf
May 13, 2019 - describe how a measure would be calculated from the
recommended data sources, uploading a separate … Although submission of formal programming code or
algorithms that demonstrate how a measure would be … To do this will require either (1) population
based datasets from all payers and providers, similar … State-level rates of readmissions do not require
these records, since CPT billing codes serve as a valid … Rogowski JA, Horbar JD, Staiger DO, et al.
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www.ahrq.gov/evidencenow/projects/state/how-to-guide/guide3.html
August 01, 2024 - However, it is important to have a plan for how to develop and maintain a broad and ongoing network of … and asked, ‘Wouldn’t you like to do some quality improvement in your practice?’ … connection. 22 Develop a Value Proposition A value proposition is a statement that explains how involvement … The EvidenceNOW cooperatives highlighted how practice facilitators taught participating practices to … Cooperatives called attention to how participation could improve overall practice functioning.
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psnet.ahrq.gov/issue/does-clinical-supervision-health-professionals-improve-patient-safety-systematic-review-and
August 04, 2021 - A systematic review and meta-analysis. … A systematic review and meta-analysis. … This systematic review examined how increased clinical supervision affects patient safety. … A systematic review and meta-analysis. … April 1, 2009
WebM&M Cases
Do Not Disturb!
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digital.ahrq.gov/2019-year-review/research-summary/using-aviation-technology-prevent-healthcare-errors-health-it
January 01, 2019 - industry’s use of a “black box” that captures actions leading up to a near miss or error, the health … wanted to find a way to identify near misses in healthcare. … Could the concept of a “black box,” a flight data recorder that has led better system design and preventing … How small inconsistencies can lead to increased errors
A second example found from the black box analysis … “They're doing that 20, 30, 40 times a day, and now all of a sudden they're in what we call automaticity
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effectivehealthcare.ahrq.gov/sites/default/files/pdf/traumatic-brain-injury-rehabilitation-future_research.pdf
January 01, 2013 - We used an
analytical framework (Figure 1) to construct the following Key Questions (KQs):
KQ 1: How … How should the severity of overall impairments be assessed and reported in effectiveness
research to … How should interventions be defined to encourage consistency and comparability across
studies and support … How do patient-centered outcomes differ depending on the setting in which rehabilitation
is provided … Guidance is available to researchers
regarding how to better describe interventions in order to enhance
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www.ahrq.gov/sites/default/files/publications/files/clabsicompanion.pdf
October 18, 2012 - unit resides may serve as a predictor of how
well a unit performs in quality improvement initiatives … confusion about how to proceed with CUSP activities, and 3) not enough buy-in
from other physician … The top three unit progress
barriers were 1) not enough time, 2) confusion about how to proceed with … Letters, case reports (n=1), historical articles, editorials, and commentaries were
excluded. … infections to the patient: a case
study in Turkey.
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effectivehealthcare.ahrq.gov/sites/default/files/related_files/abnormal-uterine-bleeding_disposition-comments.pdf
March 21, 2013 - Peer Reviewer #2 Results The results were a summary in several sections of the findings
of how to treatment … Peer reviewer #4 Results
p.25 l.33-34
How is, for example, a 121% increase in cycle regularity
established … None found benefit which may or
may not reflect how similar approaches would
be received in a U.S. … How
does this provide insight to the primary care practitioner? … the research
needed section do not seem to reflect some of the biggest
evidence gaps.
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psnet.ahrq.gov/perspective/primary-care-and-patient-safety-opportunities-interface
September 28, 2022 - A community health worker can work with the individual to show them how to get into patient portal, how … models, logistically how you make this happen, and how to do it virtually, is going to be key for some … JW: How do we measure high quality? … How do we make sure we do that? … So how do we develop a taxonomy for patient safety, and how do we improve safe discussions around patient
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www.ahrq.gov/sites/default/files/wysiwyg/research/findings/making-healthcare-safer/mhs3/care-transitions-1.pdf
March 01, 2020 - help shape the thinking about how best to improve transitional care practices. … et al. (2014) sought to identify factors that contributed to how programs
could be implemented to enhance … APNs educate patients about their health
conditions and risks, including how to recognize and manage … They use home
visits to monitor symptoms and do medication reconciliation. … .8 More strategies are also needed to determine how best to incorporate patients and
family caregivers
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psnet.ahrq.gov/node/848107/psn-pdf
April 26, 2023 - or knowledge-
based errors but do not address the whole picture or acknowledge that these errors may … erroneously linked to how easy it is to think of examples. … misdiagnosis may not reflect real-world conditions.6 The conditions under which
diagnoses are rendered do … framework for how to define and identify factors contributing to misdiagnosis. … they could be more
amenable to intervention, such as institutional uncertainty about how to begin efforts