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psnet.ahrq.gov/perspective/university-texas-system-clinical-safety-and-effectiveness-course
February 01, 2011 - of care and simultaneously reduce costs. … national meetings. … Ross Professor in Humanities and TechnologyDirector, UT Houston-Memorial Hermann Center for Healthcare … Quality and Safety Professor of Medicine University of Texas Medical School at Houston
Jan E. … from each other and national experts.
5.
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psnet.ahrq.gov/issue/sensemaking-organizations
June 20, 2018 - Book/Report
Classic
Sensemaking in Organizations. … October 31, 2016
Assessment of the National Patient Safety Initiative: Context and Baseline … Evaluation Report 1. … July 22, 2009
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health … Error Reporting and Analysis
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psnet.ahrq.gov/issue/nonpayment-harms-resulting-medical-care-catheter-associated-urinary-tract-infections
December 19, 2017 - Results from a national survey. … Centers for Medicare and Medicaid Services home health certification and plan of care and their potential … January 4, 2012
View More
Related Resources
National Healthcare … Quality and Disparities Reports. … device-associated infections during the coronavirus disease 2019 (COVID-19) pandemic: results from a national
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psnet.ahrq.gov/issue/maternal-health-women-and-girls-african-descent-americas
September 02, 2015 - Book/Report
Maternal Health of Women and Girls of African Descent in the Americas … This report examined maternal and reproductive health care for Black women in nine countries across the … The analysis found poor data collection, indifferent policies, and systemic racism and sexism as factors … contributing to disparities in care for this patient population . … Related Resources
Surveys on Patient Safety Culture Nursing Home Survey: User Database Report
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psnet.ahrq.gov/issue/impact-pharmacist-led-multidisciplinary-medication-review-safety-and-medication-cost-elderly
May 25, 2022 - 2020
Organizational readiness to change as a leverage point for improving safety: a national … March 11, 2020
Communication disparities between nursing home team members. … July 1, 2020
ISMP medication error report analysis. … December 13, 2017
Impact of pharmacist-provided medication therapy management on healthcare … quality and utilization in recently discharged elderly patients.
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psnet.ahrq.gov/node/60241/psn-pdf
February 24, 2022 - ethnic disparities, and poor quality of care. … families seeking care to compare the quality of care in settings like hospitals and NHs, among
others … lower quality of care.39,40
Unfortunately, segregation has been a historic structural problem in NHs … NHs and pointed out some potential gaps in the
survey processes meant to insure quality of care. … Association of nursing home ratings on health
inspections, quality of care, and nurse staffing with
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psnet.ahrq.gov/issue/costs-associated-adverse-drug-events-among-older-adults-ambulatory-setting
May 20, 2020 - previous study in the same patient population, investigators measured costs in the 6 weeks before and … August 11, 2021
Frequency and nature of medication errors and adverse drug events in … August 10, 2022
View More
Related Resources
National Healthcare … Quality and Disparities Reports. … : Making the Health Care System Safer through Implementation and Innovation.
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psnet.ahrq.gov/perspective/conversation-withamy-helwig-about-health-plan-patient-safety-initiatives
July 10, 2024 - We are interested in whole healthcare, quality of life, patient experience, and prevention of patient … Good data, aligned focus on high quality of care, and shared patient outcome goals are also key to successful … However, health care quality and patient safety are closely intertwined, and patient safety events often … CMS has several quality reporting and value-based payment initiatives designed to improve care quality … One study , which analyzed hospitals from 11 states, found that the quality of care for patients within
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psnet.ahrq.gov/issue/safety-measurement-and-monitoring-healthcare-framework-guide-clinical-teams-and-healthcare
September 24, 2018 - Safety measurement and monitoring in healthcare: a framework to guide clinical teams and healthcare organisations … This narrative review summarizes an in-depth report on measuring safety and monitoring improvements … processes, continuous safety monitoring, preparedness for future hazards, and learning and responding … Safety measurement and monitoring in healthcare: a framework to guide clinical teams and healthcare organisations … the willingness of English National Health Service staff to recommend their organisation.
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psnet.ahrq.gov/issue/advancing-nursing-home-quality-through-quality-improvement-itself
November 28, 2018 - August 9, 2023
Exposures to structural racism and racial discrimination among pregnant … and early post-partum Black women living in Oakland, California. … July 16, 2013
Association between hospital-reported Leapfrog Safe Practices scores and … 2021
Organizational readiness to change as a leverage point for improving safety: a national … November 23, 2011
WebM&M Cases
The Safety and Quality
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psnet.ahrq.gov/issue/eliminating-central-line-associated-bloodstream-infections-pediatric-oncology-patients
July 19, 2023 - This multimodal approach led to a significant reduction in CLABSI rates between 2020 and 2021, and an … with turnover, outcomes, and patient safety. … August 7, 2024
Racial and ethnic disparities in common inpatient safety outcomes in a … device-associated infections during the coronavirus disease 2019 (COVID-19) pandemic: results from a national … CAUTI: Final Report.
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psnet.ahrq.gov/issue/inappropriate-preinjury-warfarin-use-trauma-patients-call-safety-initiative
August 04, 2021 - View More
Related Resources
TQIP Mortality Reporting System Case Reports … May 10, 2023
ISMP medication error report analysis. … June 16, 2019
ISMP medication error report analysis. … August 7, 2013
Racial disparities in the frequency of patient safety events: results … from the National Medicare Patient Safety Monitoring System.
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psnet.ahrq.gov/issue/perceptions-hospital-electronic-health-record-ehr-training-support-and-patient-safety-staff
October 03, 2018 - Staff who were employed less than one year were more likely to report worse EHR training, and those employed … reduce disparities. … 2024
Outcomes of concurrent operations: results from the American College of Surgeons' National … February 7, 2024
Hospital staff reports of coworker positive and unprofessional behaviours … across eight hospitals: who reports what about whom?
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psnet.ahrq.gov/issue/avoid-punitive-approach-your-safety-event-reporting
October 23, 2019 - A blameless approach to error and near miss reporting is foundational to the success of the effort … October 23, 2019
Health systems and hospitals in pursuit of high reliability. … national survey. … December 2, 2020
Assessing nursing quality and patient safety. … September 9, 2020
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health
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psnet.ahrq.gov/issue/patient-safety-community-dementia-services-what-can-we-learn-experiences-caregivers-and
March 05, 2025 - March 5, 2025
Investigating the association of alerts from a national mortality surveillance … longitudinal Welsh national adverse events study. … contributory factors of medication safety incidents following hospital discharge using National Reporting … June 7, 2023
Racial disparities in preventable adverse events attributed to poor care … coordination reported in a national study of older US adults.
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psnet.ahrq.gov/node/841566/psn-pdf
December 14, 2022 - Recently you
and some colleagues from CMS and the CDC published an article about healthcare quality … quality rankings among
industrialized nations. … /
https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care … quality, safety, and equity. … reports?
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psnet.ahrq.gov/issue/older-adults-and-covid-19-implications-aging-policy-and-practice
July 18, 2018 - Special or Theme Issue
Older Adults and COVID-19: Implications for Aging Policy and … Citation Text:
Older Adults and COVID-19: Implications for Aging Policy and Practice. … June 12, 2019
View More
Related Resources
National Healthcare Quality … and Disparities Reports. … and resident deaths.
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psnet.ahrq.gov/issue/fatigue-and-safety-paramedicine
December 16, 2020 - Study
Fatigue and safety in paramedicine. … patient safety: a systematic review and meta-analysis. … diminishes racial disparities in survival after in-hospital cardiac arrests. … of health care quality among African American college students in Georgia, USA. … a national Delphi survey by the Children's Safety Initiative-Emergency Medical Services for Children
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psnet.ahrq.gov/issue/weight-stigma-and-barriers-effective-obesity-care
August 18, 2021 - Download Citation
Related Resources From the Same Author(s)
Racial disparities … May 25, 2016
National trends in patient safety for four common conditions, 2005–2011. … The Truth and Lies Early Medicine Taught Us About Women's Bodies and Why It Matters Today. … health care quality among African American college students in Georgia, USA. … August 17, 2022
Eliminating explicit and implicit biases in health care: evidence and
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psnet.ahrq.gov/issue/mistaken-identity-skin-cleansing-solution-leading-extensive-chemical-burns-extremely-preterm
October 19, 2022 - This case report describes an incident of harm due to application of the wrong cleansing solution, discusses … April 24, 2018
Design and implementation of an application and associated services to … responding equitably: application of the socioecological model to reduce racial disparities in the NICU … Patient safety incidents associated with airway devices in critical care: a review of reports … to the UK National Patient Safety Agency.