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psnet.ahrq.gov/perspective/implementing-patient-safety-program-large-national-health-system
January 01, 2008 - Our plan to achieve this included leveraging biannual corporate clinical meetings to further the quality … health record (EHR) is an essential foundational element for achieving safe and reliable care, and we plan
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www.ahrq.gov/sites/default/files/2025-02/goldman-report.pdf
January 01, 2025 - Final Progress Report: Evaluating and Improving Present-On-Admission for Performance Reporting
Evaluating and Improving Present-On-Admission for Performance Reporting
L. E lizabeth Goldman, MD, MCR, Principal Investigator
Andrew Bindman, MD, Peter Bacchetti, PhD, Co-Investigators
University of California, San …
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psnet.ahrq.gov/perspective/patient-safety-during-hospital-discharge
April 01, 2018 - communication with providers via telemedicine to mobile applications that help patients follow a postdischarge plan
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www.ahrq.gov/sites/default/files/2024-10/feudtner-report.pdf
January 01, 2024 - The research plan was guided by two main hypotheses, each of which motivated
specific research aims: … Preparticipation physical evaluations for high
school athletes: time for a new game plan.
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www.ahrq.gov/sites/default/files/2024-03/small-report.pdf
January 01, 2024 - various arrangements within these large, heterogeneous academic organizations in terms
of practice plan … Brought a feasibility study to build a network and deliver a plan to create the
Chicago Medical
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psnet.ahrq.gov/perspective/conversation-harlan-krumholz-md-sm
April 01, 2018 - communication with providers via telemedicine to mobile applications that help patients follow a postdischarge plan
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www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-hcfd-041825.pdf
April 01, 2025 - Improving Healthcare Safety by Enhancing Healthcare Facility Design
AHRQ-Funded Patient Safety
Project Highlights
Improving Healthcare Safety by
Enhancing Healthcare Facility Design
Overview
Research has shown that optimizing the physical, functional, and aesthetic details of healthcare facilitiesi
(e.g., units,…
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effectivehealthcare.ahrq.gov/sites/default/files/innovations_in_stakeholder_engagement_conference_summary2.pdf
October 01, 2011 - As part of these efforts, the EPA developed a 16-item Action Plan under CEI to help
communities meaningfully … Consider using technical advisors to
assist the community in developing a community involvement plan
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hcup-us.ahrq.gov/reports/statbriefs/sb248-Hospital-Readmissions-2010-2016.pdf
January 01, 2016 - Characteristics of 30-Day All-Cause Hospital Readmissions, 2010-2016
1
February 2019
Characteristics of 30-Day All-Cause Hospital
Readmissions, 2010–2016
Molly K. Bailey, M.S., Audrey J. Weiss, Ph.D.,
Marguerite L. Barrett, M.S., and H. Joanna Jiang, Ph.D.
Introduction
Hospital readmis…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Behara.pdf
January 01, 2004 - A Conceptual Framework for Studying the Safety of Transitions in Emergency Care
309
A Conceptual Framework for Studying the
Safety of Transitions in Emergency Care
Ravi Behara, Robert L. Wears, Shawna J. Perry,
Eric Eisenberg, Lexa Murphy, Mary Vanderhoef, Marc Shapiro,
Christopher Beach, Pat Croskerry, Ka…
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Riley_58.pdf
April 02, 2008 - from monitoring one’s surroundings and continuously
facilitating the design and redesign of the care plan … A “shared mental model” is a common
understanding of the situation and plan by all members of the team … Answers acknowledged
verbally
Shared mental model A common understanding of a problem
and the plan
-
www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/nursing-home/2023-SOPS-Nursing-Home-DB-Part-II.pdf
January 01, 2023 - (Item B1)
73% 65%
Staff are told right away when there is a change in a resident’s care plan. … (Item B1)
64% 70%
Staff are told right away when there is a change in a resident’s care plan. … (Item B1)
66% 68% 72% 63%
Staff are told right away when there is a change in a resident’s care plan … (Item B1)
65% 80%
Staff are told right away when there is a change in a resident’s care plan. … (Item B1)
71% 70% 62%
Staff are told right away when there is a change in a resident’s care plan.
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psnet.ahrq.gov/node/39960/psn-pdf
September 19, 2016 - white paper encourages hospitals to proactively develop and integrate a clinical crisis management
plan … leadership in developing a culture of safety, and the need for organizations to have a
comprehensive crisis plan … The article provides a
checklist and work plan for organizations to use in developing their plan, emphasizing
-
hcup-us.ahrq.gov/db/nation/kid/KID_2003_CORE_Volume2_M-Z.pdf
January 01, 2003 - Cross Plan: Illinois 3 Private
Insurance
130 Blue Cross Plan: Unspecified 3 Private
Insurance … : Unspecified
2 TennCare Plan: Access-Med Plus
3 TennCare Plan: Blue Cross
4 TennCare Plan: Advantage … Care/Phoenix
5 TennCare Plan: Omni Care
6 TennCare Plan: Unspecified
7 TennCare Plan: Unspecified … 8 TennCare Plan: John Deere/Heritage
9 TennCare Plan: Preferred Health Partnership
A TennCare Plan … Q TennCare Plan: TennCare Select
R TennCare Plan: Better Health Plans, Inc.
-
www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/procedure-manual/procedure-manual-appendix-iv-roles-and-responsibilities-uspstf-members-serving-topic-lead
July 01, 2017 - staff solicits volunteers for the position of primary lead from among assigned topic leads during work plan … The leads' role on a topic begins once they have received a draft work plan on the topic. … A call is then scheduled to discuss the draft work plan. … the research plan as final. … Reviewing every comment received from the public on the draft research plan and bringing other leads
-
digital.ahrq.gov/sites/default/files/docs/page/2006Dye_051111comp.pdf
June 05, 2006 - chart reviews
• Trigger tool developed based on IHI
methodology
7
Medication Error Assessment Plan … meds
Many forms/doses/quantities
Adding doses to food/feeds
13
Medication Error Assessment Plan … Pediatrics: Special challenges
3-pronged approach to measuring events
Medication Error Assessment Plan … Medication Error Assessment Plan (cont'd.) … Observation
Medication Error Assessment Plan
Trigger Tool Chart Reviews
Medication Error Assessment
-
effectivehealthcare.ahrq.gov/sites/default/files/pregnancy-horizon-scan-high-impact-1312.pdf
December 01, 2013 - Overall high-impact potential: vending machine dispensers for emergency oral
contraceptive (Plan B … *Vending machine dispensers for emergency oral contraceptive
(Plan B One-Step) to prevent pregnancy … Plan B One-Step pricing. [internet]. Santa Monica
(CA): GoodRx, Inc. … Available: http://www.goodrx.com/plan-b-
one-step.
7. … Obama administration
drops its appeal of Plan B ruling, will widen
access to drug. [internet].
-
psnet.ahrq.gov/node/34692/psn-pdf
February 10, 2011 - The economic consequences of medical injuries:
implications for a no-fault insurance plan. … Implications for a no-fault insurance plan. JAMA. 1992;267(18):2487-92. … https://psnet.ahrq.gov/issue/economic-consequences-medical-injuries-implications-no-fault-insurance-plan … https://psnet.ahrq.gov/issue/economic-consequences-medical-injuries-implications-no-fault-insurance-plan
-
hcup-us.ahrq.gov/reports/race/annotatedslidesforR_E_report2.jsp
May 01, 2016 - Office of Minority Health: National Partnership for Action to End Health Disparities' National Plan … Racial and Ethnic Health Disparities in Colorado 2009
Colorado Health Disparities Strategic Plan … to Eliminate Minority Health Disparities Plan of Action 2010-2014
NJ
Strategic Plans … for Action
Heart Disease and Stroke Prevention Rhode Island State Plan 2009
Reducing the Burden … Ethnicity: 2010
Action Plan to Eliminate Racial/Ethnic Health Disparities in the State of Utah
-
meps.ahrq.gov/data_files/publications/st18/stat18.pdf
January 01, 2000 - than in a single coverage plan. … While almost
one-third of private-sector employees with single coverage were enrolled in a plan that … and small employers, employees
with single coverage were much less likely to contribute toward their plan … In contrast, single plan employee
contributions were greater in larger firms than smaller firms by about … If a plan
offers more than one arrangement for family coverage, premium information for a family of