- 
                                        
www.ahrq.gov/sites/default/files/2025-04/nemeth-report.pdf
January 01, 2025 - Chicago: National Health Care Safety Council of the National Patient Safety Foundation, 
American Medical … Building a Better 
Delivery System: A New Engineering/Health Care Partnership.
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/cauti-sustainability.pptx
December 01, 2015 - Quality Health Care
5
Quality Health Care-
 “the degree to which health services for individuals and … populations increase the likelihood of desired health outcomes and are consistent with current professional … Incentives — Lessons from Behavioral Economics,” August 4, 2011. … Volpp, Thomas Pellathy, and George Loewenstein, “Promoting Completion of Health Risk Assessments with … System
Columbia
Maury Regional Medical Center 	
Family Health Group (100 providers)		
EMS Services
                                     
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/availability/chipra-234-fullreport.pdf
June 17, 2014 - Measure Topic – care in the most integrated setting: No. 
n. Population – other: No. 
o. … measurement, health informatics, and health care quality measurement. … or facility:** Can compare: (i) practice sites; (ii) medical or other 
professional groups; or (iii) integrated … Health IT Enhancement 
Please describe how health IT may enhance the use of this measure. … health 
IT system?
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/daily-care-processes-guide.pdf
January 01, 2017 - Public Health 
Rep. 2007 Mar-Apr;122(2):160-6. PMID: 
17357358. 
6. … Qual Saf Health Care. 2010 
Dec;19(6):555-61. PMID: 21127114. 
18. … Int 
J Qual Health Care. 2011 Oct;23(5):538-44. 
PMID: 21821603. 
27. … Implementation of a protocol for integrated 
management of pain, agitation, and delirium 
can improve … Department of Health and Human Services.
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/outcomes/chipra-146-fullreport.pdf
January 01, 2020 - Measure Topic – care in the most integrated setting: No.  
m. … or facility:** Can compare: (i) practice sites; (ii) medical or other 
professional groups; or (iii) integrated … their health … Health Information Technology
	11.A. Health IT Enhancement
	11.B. Health IT Testing
	11.C. … Health IT Workflow
	11.D. Health IT Standards
	11.E. Health IT Calculation
	11.F.
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/2024-01/malone-report.pdf
January 01, 2024 - This project addresses an important public health issue regarding improving health information 
technology … , Office of the National Coordinator for 
Health Information Technology, Department of Health and Human … Health. … Received comments were reviewed by 
workgroups and integrated into revised guidelines and standards. … that may ensue if the hazard is not averted.24, 26 The workgroup also 
recommended seven components be integrated
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/2024-02/jones-report.pdf
January 01, 2024 - Nebraska Center for Rural Health Research. Agency for Health Care Research and 
Quality. … To Err is Human: Building a Safer Health System. … care delivery: RUPRI Center for Rural Health
Policy Analysis. … Medication errors observed in 36 
health care facilities. … Creating high reliability in health care organizations.
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/topics/dxsafety-patient-experience-vol1.pdf
July 01, 2023 - Department of Health and Human Services. … Department of Health and Human Services. … The importance of integrating narrative 
into health care decision making. … Voices unheard: barriers to the expression of dissatisfaction 
with health plans. … First, do no harm: institutional betrayal and trust in health care organizations.
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/research/findings/final-reports/environmental-scan-programs/envptscan.pdf
June 01, 2013 - Target Audience Is the target audience health care 
professionals, health care students (medical 
school … Key Contacts by Partner Health Organization 
Organization Key Contact 
Sisters of Saint Mary Health … Care Error Training 
Health Care Quality Improvement 
Health Literacy Training 
Healthcare Error … Assessment Education 
Patient Health Care Training 
Patient Health Education 
Patient Health Education … care providers, physicians, allied health professionals,         
nurses, health care executives and
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/demoeval/what-we-learned/highlight13.pdf
September 08, 2015 - How did CHIPRA quality demonstration States employ learning collaboratives to improve children's health … care for children enrolled in Medicaid 
and the Children’s Health Insurance Program 
(CHIP). … • Applying health information technology (IT) 
for quality improvement. … • Investigating a model format for pediatric 
electronic health records (EHRs). … Internal report from Tri-State Children’s 
Health Improvement Consortium (T-CHIC).
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Adams-Pizarro_109.pdf
January 08, 2008 - from the 
ED Collaborative Improvement Guide.12 These change ideas represented a mix of systems and 
behavioral … Crossing the quality chasm: A 
new health system for the 21st century. … Implementing  
       culture change in health care: Theory and practice. … Health and Safety Commission. … Qual Saf Health Care 2003; 12: 17-23. 
6.  Sorra J, Nieva V.
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/2024-04/pines-mccarthy-report.pdf
January 01, 2024 - STRUCTURED ABSTRACT 
Purpose and Scope: Emergency department (ED) crowding is a major public health … McCarthy, both of whom serve on the faculty in the Departments of Emergency 
Medicine and Health Policy … in the ED include inpatient bed capacity strategies, 
electronic information systems that are fully integrated … Health Aff (Millwood). 2008;27:w84-
95.  
3 Horwitz LI, Bradley EH. … Natl Health  Stat Report. 2008;7:1-38. 
13  Centers for Disease Control.
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/sops101-webcast-transcript-ad.pdf
June 01, 2020 - Public Health Service (Presenter) 
Theresa Famolaro, M.P.S., M.S., M.B.A. … Brady also serves as an 
Assistant Surgeon General in the Commissioned Corps of the US Public Health … She has more than 20 years of experience in public health research and quality 
improvement, including … Gray, Slide 21 
Then, released in 2018, the SOPS Health Information Technology, or Health IT, patient … IT use on patient safety, including the unintended consequences of health IT.
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/apcd/apcdmeasinvrpt.pdf
January 01, 2020 - health management 
applications. … include: 
• Uninsured patients who, because they pay entirely out of pocket do not have claims; 
• Some behavioral … Population health measures may 
address health status outcomes of a population, whether health is equitably … An environmental scan of integrated approaches for defining and measuring total 
population health by … Population health measures may address health status outcomes of a population, whether health is equitably
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Whitten_85.pdf
June 05, 2008 - News Media and Health Care Providers at the Crossroads of Medical Adverse Events
News Media and Health … • Assisting health care providers in reducing medical errors. … Results: Health Care Providers 
Focus group findings addressed the perceptions of health care professionals … Summary: Health Care Providers 
Health care providers acknowledge the benefits of reporting adverse medical … The survey targeted people who covered health news.
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/2024-01/bates-report.pdf
January 01, 2024 - Safety Across the Clinical Settings Project:   
1)  Evaluation of a uniform reporting system across an integrated … The Center also included 
leadership from the Partners and Fallon Healthcare Systems, two large integrated … of the errors identified may have been detected 
through appropriate decision support capabilities integrated … • To disseminate the results of these assessments to appropriate and constituents 
in the integrated … Vital and Health Statistics  1983;75:1-60  
13.
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/2025-02/peterson-report.pdf
January 01, 2025 - perhaps physically or mentally impaired, and having special 
healthcare needs; they may be in declining health … the resident, who is usually 
elderly, is perhaps physically or mentally impaired, and has special health … prevention of MRSA in LTCF patients should be both medically and 
economically beneficial to the US health … We developed a successful approach for 
controlling MRSA in LTCFs that has improved the health of residents
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/Lion-Mangione-Britto.pdf
October 01, 2011 - Clinical measures: Improved referral to mental health and pharmacy services. … , vitality, social 
functioning, and mental health, p , .05 for each). … Health Plans and Providers. … Comprehensive primary care for children with special 
health care needs in rural areas. … Quality Management in Health Care, 20(2), 89–97.
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/implementation/imp_ssibundle_facnotes.docx
December 01, 2017 - Department of Health and Human Services
	Slide 9
	Barrier Identification and Mitigation
ASK:
How do … This is true across many organizations, but especially true in health care.
                                     
                                                                    - 
                                        
www.ahrq.gov/hai/tools/surgery/modules/implementation/ssi-bundle-fac-notes.html
October 01, 2020 - Department of Health and Human Services. … This is true across many organizations, but especially true in health care.