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digital.ahrq.gov/sites/default/files/docs/publication/uc1hs015319-sullivan-final-report-2007.pdf
January 01, 2007 - The most frequently occurring error characteristic was missing information, followed by
incorrect directions
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digital.ahrq.gov/location/usa-ca-davis
January 01, 2023 - USA, CA, Davis
School-Based Tele-Physiatry Assistance for Rehabilitative and Therapeutic Services for Children with Special Health Care Needs Living in Rural and Underserved Communities
Description
This study examined parent and provider experiences and care costs for in-perso…
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digital.ahrq.gov/sites/default/files/docs/publication/r18hs017203-gurwitz-final-report-2011.pdf
January 01, 2011 - Drug-related incidents occurring
during the 1-45 day period following hospital discharge were considered … Drug-related incidents occurring during the course of the hospitalization were not
considered relevant
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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/root-cause-analysis
January 01, 2023 - Root Cause Analysis
Acronym
RCA
Examples
Latino RJ. The "5 PS" concept. Patient safety: the PROACT root cause analysis approach. Boca Raton, FL: CRC Press; 2009. p. 77-86.
Latino RJ. Case studies. Patient safety: the PROACT root cause analysis approach. Boca Raton, FL: CRC Press; 2009. p. …
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digital.ahrq.gov/sites/default/files/docs/publication/r21hs018214-olson-final-report-2012.pdf
January 01, 2012 - Healthy Teens TXT ME: Information Technology to Change Teen Health Risk Behaviors - Final Report
1
TXT ME; IT to change teen health risk behaviors
Ardis L. Olson MD, PI
Research Team Members: Christina Divoll BA, Cecelia Gaffney Med,
Rachel Sarnoff BA, Heather Binnie BA
Ge…
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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/critical-incident
January 01, 2023 - Critical Incident
Description
The critical incident method is utilized to identify a process, subprocess, or problem that can be fixed or enhanced. It can also be used to identify a source of a performance deficiency. The technique attempts to find information pertaining to organizational problems, an…
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digital.ahrq.gov/sites/default/files/docs/workflowtoolkit/GroundRulesForConductingaRiskAssessment.pdf
January 01, 2010 - Ground rules for conducting a proactive risk assessment
Ground Rules for Conducting a Risk Assessment
• Clearly define the process. (For example, “followup for high risk diabetics.”)
• Limit the scope. (For example, “diabetics with poor compliance.”)
• Ensure that the process selected is relevant to the health …
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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/needs-assessment
January 01, 2023 - Needs Assessment
Examples
Walker J, Bieber E, Richards F, et al. Appendix 2: physician reporting and digital storage system needs assessment - endoscopy suite. In: Walker J, Bieber E, Richards F, editors. Implementing an electronic health record system. London: Springer; 2005. p. 183-91.
Des…
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digital.ahrq.gov/ahrq-funded-projects/systems-engineering-approach-improving-medication-safety-clinician-use-health/annual-summary/2010
January 01, 2010 - A Systems Engineering Approach: Improving Medication Safety with Clinician Use of Health IT - 2010
Project Name
A Systems Engineering Approach: Improving Medication Safety with Clinician Use of Health IT
Principal Investigator
Singh, Gurdev
Organization
State University of Ne…
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digital.ahrq.gov/sites/default/files/docs/citation/r01hs023582-stockwell-final-report-2019.pdf
January 01, 2019 - The denominator for these analyses
included any child with a visit occurring during the study period … both as a captured opportunity at a visit in which the denominator included any child with a visit
occurring
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digital.ahrq.gov/principal-investigator/yellowlees-peter-m
February 28, 2023 - Yellowlees, Peter M.
A Clinical Trial to Validate an Automated Online Language Interpreting Tool With Hispanic Patients Who Have Limited English Proficiency - Final Report
Citation
Yellowlees P. A Clinical Trial to Validate an Automated Online Language Interpreting Tool With H…
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digital.ahrq.gov/ahrq-funded-projects/enhancing-providers-ability-followup-abnormal-test-results
January 01, 2023 - Enhancing Providers' Ability to Follow Up on Abnormal Test Results
Project Final Report ( PDF , 632.73 KB) Disclaimer
Disclaimer
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the v…
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digital.ahrq.gov/sites/default/files/docs/page/08-0085_bcma.pdf
August 01, 2008 - Layout 1
Agency for Healthcare Research and Quality
Advancing Excellence in Health Care www.ahrq.gov Health IT
AHRQ's Health IT Portfolio. AHRQ’s health information technology (health IT) initiative is
part of the Nation’s strategy to put information technology to work in health care. By developing
secure and privat…
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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/fault-tree-analysis
January 01, 2023 - Fault Tree Analysis
Acronym
FTA
Description
Fault tree analyses (FTAs) study specific system, process, or product failures using a tree diagram . The process can be used to study a failure that actually occurred, or it could study a potential failure. The technique starts with the failure an…
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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/pareto-chart
January 01, 2023 - Pareto Chart
Also Known As
Pareto Diagram
Description
A pareto chart is a bar graph where the bars appear in decreasing length from left to right. The bar length corresponds to time, frequency, or amount.
Uses
When you want to find the most significant causes or problems from a l…
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digital.ahrq.gov/sites/default/files/docs/transforming-guidelines-action-qas-06152023.pdf
June 15, 2023 - AHRQ Webinar: Transforming Guidelines Into Action: Clinical Decision Support at the Point of Care - Q&As
AHRQ National Webin…
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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/decision-tree
January 01, 2023 - Decision Tree
Also Known As
Decision Process Flowchart
Logic Diagram
Description
Decision trees are tools that can be utilized to navigate several courses of action to arrive on one choice. Their structure allows one to evaluate multiple options and explore what the potential outcomes ar…
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digital.ahrq.gov/ahrq-funded-projects/development-and-evaluation-patient-reported-outcome-score-visualization-improve
January 01, 2023 - Development and Evaluation of Patient-Reported Outcome Score Visualization to Improve Their Utilization (PROVIZ)
Project Final Report ( PDF , 1.06 MB) Disclaimer
Disclaimer
The findings and conclusions in this document are those of the author(s), who are responsible for its conte…
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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/process-0
January 01, 2023 - Process Mapping
Use Case
Description
A use case is a set of instructions that an individual in a process completes to go through one single step in that process. It describes what the user does to interact with a system.
Value Stream Mapping
Descr…
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digital.ahrq.gov/organization/university-california-davis
January 01, 2023 - University of California, Davis
School-Based Tele-Physiatry Assistance for Rehabilitative and Therapeutic Services for Children with Special Health Care Needs Living in Rural and Underserved Communities
Description
This study examined parent and provider experiences and care c…