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psnet.ahrq.gov/issue/did-hospital-readmissions-reduction-program-reduce-readmissions-assessment-prior-evidence-and
August 25, 2021 - Study
Did the Hospital Readmissions Reduction Program reduce readmissions? An assessment of prior evidence and new estimates.
Citation Text:
Ziedan E, Kaestner R. Did the Hospital Readmissions Reduction Program reduce readmissions? An assessment of prior evidence and new estimates. Eval …
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psnet.ahrq.gov/issue/prescription-opioid-dose-reductions-and-potential-adverse-events-multi-site-observational
March 04, 2020 - Study
Prescription opioid dose reductions and potential adverse events: a multi-site observational cohort study in diverse US health systems.
Citation Text:
Metz VE, Ray GT, Palzes V, et al. Prescription opioid dose reductions and potential adverse events: a multi-site observational coho…
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psnet.ahrq.gov/issue/deaths-among-opioid-users-impact-potential-inappropriate-prescribing-practices
October 19, 2011 - Study
Deaths among opioid users: impact of potential inappropriate prescribing practices.
Citation Text:
Jayawardhana J, Abraham AJ, Perri M. Deaths among opioid users: impact of potential inappropriate prescribing practices. Am J Manag Care. 2019;25(4):e98-e103.
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psnet.ahrq.gov/issue/assessment-fda-risk-evaluation-and-mitigation-strategy-transmucosal-immediate-release
January 22, 2020 - Study
Emerging Classic
Assessment of the FDA Risk Evaluation and Mitigation Strategy for transmucosal immediate-release fentanyl products.
Citation Text:
Rollman JE, Heyward J, Olson L, et al. Assessment of the FDA Risk Evaluation and Mitigation Strategy for Tra…
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psnet.ahrq.gov/issue/failure-rescue-deteriorating-patients-systematic-review-root-causes-and-improvement
January 18, 2013 - Review
Emerging Classic
Failure to rescue deteriorating patients: a systematic review of root causes and improvement strategies.
Citation Text:
Burke JR, Downey C, Almoudaris AM. Failure to rescue deteriorating patients: a systematic review of root causes and im…
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psnet.ahrq.gov/issue/relationship-between-leapfrog-safe-practices-survey-and-outcomes-trauma
August 02, 2015 - Study
Relationship between Leapfrog Safe Practices Survey and outcomes in trauma.
Citation Text:
Glance LG, Dick AW, Osler T, et al. Relationship between Leapfrog Safe Practices Survey and outcomes in trauma. Arch Surg. 2011;146(10):1170-7. doi:10.1001/archsurg.2011.247.
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psnet.ahrq.gov/issue/self-reported-patient-safety-competence-among-new-graduates-medicine-nursing-and-pharmacy
February 14, 2015 - Study
Self-reported patient safety competence among new graduates in medicine, nursing and pharmacy.
Citation Text:
Ginsburg LR, Tregunno D, Norton PG. Self-reported patient safety competence among new graduates in medicine, nursing and pharmacy. BMJ Qual Saf. 2013;22(2):147-54. doi:10…
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psnet.ahrq.gov/issue/cognitive-biases-encountered-physicians-emergency-room
June 19, 2024 - Study
Cognitive biases encountered by physicians in the emergency room.
Citation Text:
Kunitomo K, Harada T, Watari T. Cognitive biases encountered by physicians in the emergency room. BMC Emerg Med. 2022;22(1):148. doi:10.1186/s12873-022-00708-3.
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psnet.ahrq.gov/issue/medication-errors-care-transition-trauma-patients
September 02, 2020 - Study
Medication errors in the care transition of trauma patients
Citation Text:
Martín Mª ÁP, García MM, Silveira ED, et al. Medication errors in the care transition of trauma patients. Eur J Clin Pharmacol. 2019;75(12):1739-1746. doi:10.1007/s00228-019-02757-3.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module4/mod4-event-checklist.pdf
April 01, 2016 - Purpose: To provide a checklist for the required actions that need to be taken following an event.
Who should use this tool? The Communication and Optimal Resolution Toolkit (CANDOR) Response Team or
designee, unless otherwise indicated.
How to use this tool: Use the checklist to ensure that appropriate action is t…
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psnet.ahrq.gov/issue/diagnostic-delays-among-covid-19-patients-second-concurrent-diagnosis
March 08, 2023 - Study
Diagnostic delays among COVID-19 patients with a second concurrent diagnosis.
Citation Text:
Freund O, Azolai L, Sror N, et al. Diagnostic delays among COVID‐19 patients with a second concurrent diagnosis. J Hosp Med. 2023;18(4):321-328. doi:10.1002/jhm.13063.
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www.ahrq.gov/patient-safety/settings/hospital/candor/modules/checklist4.html
August 01, 2022 - CANDOR Event Checklist
AHRQ Communication and Optimal Resolution Toolkit
Purpose: To provide a checklist for the required actions that need to be taken following an event.
Who should use this tool? The Communication and Optimal Resolution (CANDOR) Response Team or designee, unless otherwise indicated.
…
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psnet.ahrq.gov/issue/are-online-patient-reviews-associated-health-care-outcomes-systematic-review-literature
September 16, 2020 - Review
Are online patient reviews associated with health care outcomes? A systematic review of the literature.
Citation Text:
Placona AM, Rathert C. Are online patient reviews associated with health care outcomes? A systematic review of the literature. Med Care Res Rev. 2022;79(1):3-16. …
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www.ahrq.gov/news/newsroom/case-studies/ktcoe33.html
October 01, 2014 - Iowa Medicaid Uses AHRQ Research, Data to Improve Quality
Search All Impact Case Studies
March 2010
As a result of participating in the Medicaid Medical Directors Learning Network—an AHRQ Knowledge Transfer project—the Iowa Medicaid Enterprise, in consultation with the Iowa Foundation for Medical Care, used…
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psnet.ahrq.gov/issue/hospital-admissions-associated-medication-non-adherence-systematic-review-prospective
August 28, 2013 - Review
Emerging Classic
Hospital admissions associated with medication non-adherence: a systematic review of prospective observational studies.
Citation Text:
Mongkhon P, Ashcroft DM, Scholfield N, et al. Hospital admissions associated with medication non-adhere…
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psnet.ahrq.gov/issue/impact-sample-size-variation-adverse-events-and-preventable-adverse-events-systematic-review
May 15, 2024 - Review
Impact of sample size on variation of adverse events and preventable adverse events: systematic review on epidemiology and contributing factors.
Citation Text:
Lessing C, Schmitz A, Albers B, et al. Impact of sample size on variation of adverse events and preventable adverse eve…
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psnet.ahrq.gov/issue/patient-participation-surgical-site-marking-can-be-additional-tool-help-avoid-wrong-site
March 14, 2022 - Study
Patient participation in surgical site marking: can this be an additional tool to help avoid wrong-site surgery?
Citation Text:
Bergal LM, Schwarzkopf R, Walsh M, et al. Patient participation in surgical site marking: can this be an additional tool to help avoid wrong-site surger…
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psnet.ahrq.gov/issue/use-patient-digital-facial-images-confirm-patient-identity-childrens-hospitals-anesthesia
May 06, 2009 - Study
The use of patient digital facial images to confirm patient identity in a children's hospital's anesthesia information management system.
Citation Text:
Thomas JJ, Yaster M, Guffey P. The Use of Patient Digital Facial Images to Confirm Patient Identity in a Children's Hospital's An…
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psnet.ahrq.gov/issue/frequency-and-risk-factors-medication-errors-pharmacists-during-order-verification-tertiary
January 23, 2013 - Study
Frequency of and risk factors for medication errors by pharmacists during order verification in a tertiary care medical center.
Citation Text:
Gorbach C, Blanton L, Lukawski BA, et al. Frequency of and risk factors for medication errors by pharmacists during order verification in a…
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psnet.ahrq.gov/issue/interventions-prevent-falls-older-adults-updated-evidence-report-and-systematic-review-us
November 14, 2018 - Review
Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force.
Citation Text:
Guirguis-Blake JM, Perdue LA, Coppola EL, et al. Interventions to prevent falls in older adults: updated evidence report and syst…