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9101. Reports and Other Publications | Agency for Healthcare Research and Quality
      www.ahrq.gov/ncepcr/reports/index.html
      August 01, 2025 - Reports and Other Publications AHRQ’s Investments in Primary Care Research for 2023 and 2024  NCEPCR’s second comprehensive report is a review of AHRQ’s recent investments in primary care research – covering federal fiscal years (FYs) 2023 and 2024. The report includes an update on the activities of AHRQ’s NC…

9102. AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department Visits | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/prevhosp/timeline.html
      June 01, 2017 - AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department Visits Implementation Materials: Implementation Steps and Timeline The goal of the On-Time program is to incorporate the On-Time reports into day-to-day prevention activities and to ensure multidisciplinary input in…

9103. September: A Month for Increasing Awareness About Sepsis | Agency for Healthcare Research and Quality
      www.ahrq.gov/news/newsletters/e-newsletter/973.html
      September 01, 2025 - September: A Month for Increasing Awareness About Sepsis Issue Number 973 AHRQ News Now is a weekly newsletter that highlights agency research and program activities. September 3, 2025 Today’s Headlines: September: A Month for Increasing Awareness About Sepsis . Opportunities for Diagnosis and Treatment…

9104. Puh-Impsteps (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/pruhealing/puh-impsteps.docx
      June 02, 2025 - AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Healing Implementation Steps and Timeline The goal of the On-Time program is to incorporate the On-Time reports into day-to-day prevention activities and to ensure multidisciplinary input into clinical intervention decisions. We created the Implementation…

9105. Patient and Family Involvement in Care of Mechanically Ventilated Patients: Facilitator Guide | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/tools/mvp/modules/cusp/patient-family-care-fac-guide.html
      March 01, 2017 - Patient and Family Involvement in Care of Mechanically Ventilated Patients: Facilitator Guide AHRQ Safety Program for Mechanically Ventilated Patients Slide 1: Patient and Family Involvement in Care of Mechanically Ventilated Patients Say: This module is about patient and family involvement in patient c…

9106. Project Report - Lean Sigma
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/implement/teamwork.pptx
      January 01, 2007 - Project Report - Lean Sigma 1 1 Learning Objectives 2 Identify and apply effective communication strategies from CUSP and TeamSTEPPS® Recognize the importance of effective communication Identify barriers to communication Describe the connection between communication and medical errors 2 Basic Compon…

9107. Introduce CUSP
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/learn/learncusp.pptx
      April 01, 2011 - Introduce CUSP 1 Learning Objectives Review the impact of errors and patient harm and the underlying causes of errors Show how CUSP supports other quality and safety tools Describe Comprehensive Unit-based Safety Program (CUSP) framework and the goals of the CUSP Toolkit Demonstrate how to apply the CUSP T…

9108. Creative Strategies to Improve Patient Care Experience - Part 3 Nemhard (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/cahps-creative-strategies-nembhard.pdf
      January 01, 2014 - Creative Strategies to Improve Patient Care Experience - Part 3 Nemhard Creative Strategies to Improve Patient Care Experience Presenters (from the Yale Team) Ingrid Nembhard, PhD, MS Associate Professor The Wharton School University of Pennsylvania Yuna Lee, PhD, MPH Assistant Professor Mailman School of Publ…

9109. Improving Patient Experience: Data Analysis Methods webcast - VA (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/data-analysis-webcast-examples-3.pdf
      March 03, 2021 - Improving Patient Experience: Data Analysis Methods webcast - VA Examples of Patient Experience Improvement: Veterans Health Administration Jennifer Purdy: Executive Director, VA Patient Experience Program Jim Schaefer: Director of Surveys , Analytics & Performance Integration Webcast Sponsored by AHRQ March 3,…

9110. Re-engineering Postnatal Unit Care and the Transition Home to Reduce Perinatal Morbidity and Mortality | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/resources/learning-lab/re-engineering-postnatal-unit-care-long-desc.html
      April 01, 2025 - Re-engineering Postnatal Unit Care and the Transition Home to Reduce Perinatal Morbidity and Mortality Principal Investigator: Alison Stuebe, M.D., M.Sc., University of North Carolina, Chapel Hill, NC.  Co-PIs:  Kristin Tully, Ph.D., University of North Carolina, Chapel Hill, NC; Emily Patterson, Ph.D., The Oh…

9111. Personal Health Information Management and Design of Consumer Health Information Technology - 2009 | Digital Healthcare Research
      digital.ahrq.gov/ahrq-funded-projects/personal-health-information-management-and-design-consumer-health-it/annual
      January 01, 2023 - Personal Health Information Management and Design of Consumer Health Information Technology - 2009 Project Name Personal Health Information Management and Design of Consumer Health IT Principal Investigator Peterson, Anne Organization Insight Policy Research, Inc. Con…

9112. Spotlight Case [MONTH] 2003 (ppt file)
      psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.251_slideshow.ppt
      October 01, 2011 - Spotlight Case [MONTH] 2003 Spotlight Case Mobility Lost in the ICU * * Source and Credits This presentation is based on the October 2011 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Jim Smith, PT, DPT, MA; Associate Professor of Physical …

9113. Spotlight Case [MONTH] 2003 (ppt file)
      psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.64_slideshow.ppt
      June 01, 2004 - Spotlight Case [MONTH] 2003 Spotlight Case June 2004 The Wrong Shot: Error Disclosure Source and Credits This presentation is based on the June 2004 AHRQ WebM&M Spotlight Case in Pediatrics CME credit is available through the Web site See the full article at http://webmm.ahrq.gov Commentary by: Thomas H. …

9114. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33636/psn-pdf
      July 01, 2006 - Key Issues in Developing a Successful Hospital Safety Program July 1, 2006 Whittington JC. Key Issues in Developing a Successful Hospital Safety Program. PSNet [internet]. 2006. https://psnet.ahrq.gov/perspective/key-issues-developing-successful-hospital-safety-program Perspective What are the key success factors…

9115. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33713/psn-pdf
      June 01, 2011 - The Safety of Medical Devices June 1, 2011 Nemeth CP. The Safety of Medical Devices. PSNet [internet]. 2011. https://psnet.ahrq.gov/perspective/safety-medical-devices Perspective Edward Tenner is right. Technology does have reverberations, including unintended consequences, or "revenge effects."(1) While such dra…

9116. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49524/psn-pdf
      November 01, 2006 - Secured But Not Always Safe November 1, 2006 Jahr JS, Hosseini P. Secured But Not Always Safe. PSNet [internet]. 2006. https://psnet.ahrq.gov/web-mm/secured-not-always-safe The Case An 84-year-old healthy woman underwent an elective left total knee replacement for degenerative osteoarthritis. She received spinal …

9117. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49460/psn-pdf
      September 01, 2004 - Security Lapse September 1, 2004 Mason D. Security Lapse. PSNet [internet]. 2004. https://psnet.ahrq.gov/web-mm/security-lapse The Case A medical student learned that the hospital's radiology image library was accessible throughout the university's computer system, meaning that patient x-rays could be viewed in d…

9118. Evidence Gaps Research Taxonomy Table: Research Gaps for Screening and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years (pdf file)
      www.uspreventiveservicestaskforce.org/home/getfilebytoken/xBhJwGtUHqmEvPg_gKk4nw
      January 01, 2001 - Evidence Gaps Research Taxonomy Table: Research Gaps for Screening and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years Evidence Gaps Research Taxonomy Table Research to Address Evidence Gaps in Preventive Services for the USPSTF Topic: Research Gaps for Screening and Prevent…

9119. EvidenceNOW Managing Unhealthy Alcohol Use: Michigan Sustained Patient-centered Alcohol-Related Care (MI-SPARC) (pdf file)
      integrationacademy.ahrq.gov/sites/default/files/2020-12/Grantee%20Profile%20MI-SPARC.pdf
      January 01, 2020 - EvidenceNOW Managing Unhealthy Alcohol Use: Michigan Sustained Patient-centered Alcohol-Related Care (MI-SPARC) Michigan Program Name: Michigan Sustained Patient- centered Alcohol-Related Care (MI-SPARC) Lead Organizations: Altarum Institute Ann Arbor, MI Kaiser Permanente Washington Health Research Institute (…

9120. Second Victims: Support for Clinicians Involved in Errors and Adverse Events | PSNet
      psnet.ahrq.gov/primer/second-victims-support-clinicians-involved-errors-and-adverse-events
      December 15, 2024 - Second Victims: Support for Clinicians Involved in Errors and Adverse Events Citation Text: Second Victims: Support for Clinicians Involved in Errors and Adverse Events. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Cit…