-
ce.effectivehealthcare.ahrq.gov/hai/tools/surgery/modules/implementation/learn-from-defects-fac-notes.html
December 01, 2017 - Try to find out what exactly led to the defect. … Simulate the process that led to the defect. … Ask:
Were these contributing factors that led to or exacerbated the harm? … What led to the next factor that contributed to the defect occurring? … Incompatible blood types could have led to an egregious patient harm.
-
ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/implementation/imp_learn_from_defects_facnotes.docx
December 01, 2017 - Try to find out what exactly led to the defect. … Simulate the process that led to the defect. … ASK:
Were these contributing factors that led to or exacerbated the harm? … What led to the next factor that contributed to the defect occurring? … Incompatible blood types could have led to an egregious patient harm.
-
ce.effectivehealthcare.ahrq.gov/questions/resources/diagnosis/step2.html
November 01, 2020 - Support groups may or may not be led by experts. … Self-help groups are similar to support groups but usually are led by the participants.
-
ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/tpc/tpc-profile-scholle.pdf
April 01, 2015 - care processes were
more comprehensive and efficient after formal transformation activities, which led … that having
the authority to make decisions empowered
them to be more involved in patient care
and led
-
ce.effectivehealthcare.ahrq.gov/news/newsroom/case-studies/coe0605.html
October 01, 2014 - focusing specifically on testing, prevention, and treatment of coronary disease for women, but it also led … community to a number of issues, such as the disparity of care and differences in outcomes by gender, and led
-
ce.effectivehealthcare.ahrq.gov/news/newsroom/case-studies/cquips1302.html
December 01, 2012 - For the past 3 years, AHRQ's survey implementation has been the responsibility of the MLH team led by … Sharing survey findings within the organization has increased awareness and led to the development of
-
ce.effectivehealthcare.ahrq.gov/funding/grantee-profiles/grtprofile-desalvo.html
October 01, 2016 - This led to her research on topics such as hypertension, cardiovascular disease, and post-traumatic stress … DeSalvo led efforts to rebuild with an innovative model of neighborhood-based primary care and mental
-
ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/patient-safety/PrimaryCareEffortsToReduceReadmissions-envscan.pdf
March 01, 2020 - Programs in Independent Primary Care Practices ....................... 24
Readmission Reduction Efforts Led … Med
Care 2012;50(1):50-
7
• A physician-led health
care system in
Pennsylvania. … Finally, the last set of articles examines care coordination interventions led
by payers.
19 … Similarly, a pre-post analysis by Farrell, evaluated a transition management intervention
led by care … • North Carolina,
community-based,
physician-led
program for
establishing
PCMH for
Medicaid
-
ce.effectivehealthcare.ahrq.gov/hai/tools/mvp/modules/cusp/learn-from-defects-fac-guide.html
February 01, 2017 - Asking the question, "What led to the need to search for and borrow the missing supply or equipment?" … Try to discover what exactly led to the defect. Why were particular decisions made? … Now, ask as many relevant questions as you can think of to discover what led to the defect. … Develop a "system perspective" to see the hidden factors that led to the event. … Was there something about the overall culture or the "people side" that led to the defect?
-
ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/safety/learning-antibiotic-adverse-events-form.docx
November 01, 2019 - purpose of this tool is to provide a structured approach to help providers identify the steps that led
-
ce.effectivehealthcare.ahrq.gov/teamstepps-program/about/acknowledgments.html
July 01, 2023 - TeamSTEPPS Acknowledgments
The 2023 updates to the TeamSTEPPS 3.0 curriculum and Pocket Guide were led
-
ce.effectivehealthcare.ahrq.gov/diagnostic-safety/tools/engaging-patients-improve.html
July 01, 2022 - References
Combined reference list (PDF, 351 KB)
Acknowledgments
Project Team
This project was led … MedStar Health Research Institute, Baylor College of Medicine, Clinical Directors Network, National Nurse-Led
-
ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/iowa-case-study.pdf
January 29, 2021 - Other key
factors in success were a well-formed collaborative team led by a
dedicated physician and … Senior IT
engineers and the chief medical informatics officer supported this work and led the Epic template
-
ce.effectivehealthcare.ahrq.gov/questions/videos/patient-mcgregor.html
November 01, 2020 - Alastair McGregor
Patient and Clinician Videos
A close call with blood pressure medicine led
-
ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/officebasedcare/handouts/evaluating.pdf
December 09, 2015 - Followup visits for HbA1c testing is notoriously unreliable, and poor HbA1c
control has led to serious
-
ce.effectivehealthcare.ahrq.gov/ncepcr/research-transform-primary-care/transform/impactgrants/impact-profile-pa.html
April 01, 2015 - This led to the development of trust between partners statewide, which was critical to the program's … The relationships built from this project led to the development of a State Innovation Model grant through … PA SPREAD also led to the formation of a national advisory group.
-
ce.effectivehealthcare.ahrq.gov/funding/grantee-profiles/grtprofile-mcginn.html
January 01, 2024 - This led Dr. … This led to significant declines in inappropriate antibiotic and diagnostic test ordering.
-
ce.effectivehealthcare.ahrq.gov/ncepcr/tools/transform-qi/deliver-facilitation/curriculum/front-matter.html
February 01, 2022 - AHRQ's Developing and Running a Primary Care Practice Facilitation Program: A How-To Guide—an effort led … by much of the same team that led the development of this curriculum.
-
ce.effectivehealthcare.ahrq.gov/research/findings/factsheets/translating/action4/index.html
February 01, 2021 - Each ACTION 4 partnership is led by a prime organization. … Each of the 14 ACTION 4 partnerships is led by a prime organization and is composed of diverse member
-
ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/changing-system-facilitator-guide.docx
June 01, 2021 - A problem that almost led to patient or resident harm is called a “near-miss.” … consider the resident’s poor outcome, which was an allergic reaction to amoxicillin/clavulanic acid which led … Has the policy led to unintended consequences? … results of diagnostic tests are not available when the time out is performed at around 48 hours, has that led