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301. AHRQ Transforming Primary Care Grants | Agency for Healthcare Research and Quality
     www.qualitymeasures.ahrq.gov/ncepcr/research-transform-primary-care/transform/tpcbib/index.html
     May 01, 2015 - Hemoglobin A1c and blood pressure values in patients with diabetes were not significantly different between … The number of hospitalizations for unintentional injury and asthma also decreased after implementation … PMID: 23690385 The authors compared emergency care usage for any reason, asthma, and unintentional injury … As a comparison, emergency care use for unintentional injury had been increasing before and during implementation … Among patients with hypertension, frequent in-person visits were associated with better blood pressure

302. AHRQ Transforming Primary Care Grants Bibliography | Agency for Healthcare Research and Quality
     www.qualitymeasures.ahrq.gov/ncepcr/reports/grants-transform/bibliography/index.html
     February 01, 2017 - Hemoglobin A1c and blood pressure values in patients with diabetes were not significantly different between … The number of hospitalizations for unintentional injury and asthma also decreased after implementation … PMID: 23690385 The authors compared emergency care usage for any reason, asthma, and unintentional injury … As a comparison, emergency care use for unintentional injury had been increasing before and during implementation … Among patients with hypertension, frequent in-person visits were associated with better blood pressure

303. Tool 5: How To Conduct a Postdischarge Followup Phone Call | Agency for Healthcare Research and Quality
     www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/red/toolkit/redtool5.html
     March 01, 2013 - Resources CANDOR Family-Centered Rounds Toolkit MATCH Toolkit NICU Toolkit Pressure … Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI

304. Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool (pdf file)
     www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-143-fullreport.pdf
     April 01, 2018 - This measure calculates the rate of adverse events (patient harm)—defined as unintended physical injury … Black and Hispanic newborns are at higher risk of birth trauma (Miller, et al., 2003). … Although AEs most often result in transient harms, some lead to permanent injury and death. … : "Naloxone administration," “Health care- associated infections: positive C. difficile test,” and "Pressure … Internal pressures, such as a punitive culture that leads to underreporting of medical errors, may influence

305. Implement Teamwork and Communication for Perinatal Safety (pdf file)
     www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/implement/implement-facilitator-guide.pdf
     May 01, 2017 - communication breakdowns are identified as the primary root cause of maternal and perinatal deaths and injuries … Other root causes for maternal and perinatal deaths and injuries are— • Assessment, • Leadership, … Example: The nurse says to the doctor, “Doctor, the patient’s blood pressure is dropping; it is 60

306. Improving Patient Safety in Ambulatory Surgery Centers: A Resource List for Users of the AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture. (pdf file)
     www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/asc/resources/asc-resource_list.pdf
     March 01, 2016 - Staffing, Work Pressure, and Pace ................................ 4 Composite 4. … Effective Crisis Management Living a Culture of Patient Safety Policy and Brochure Medically Induced Trauma … Staffing, Work Pressure, and Pace 1. … portfolio aims to identify risks and hazards that lead to medical errors and find ways to prevent patient injury … Staffing, Work Pressure, and Pace Composite 4. Teamwork Composite 5. Staff Training Composite 6.

307. Timely Fluid Bolus for Children With Severe Sepsis or Septic Shock (pdf file)
     www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0231-fullreport.pdf
     May 01, 2018 - Unlike adults, the diagnosis of septic shock in children does not require the presence of low blood pressure … (hypotension), as children often maintain normal blood pressure until the advanced stages of shock … A limited window of opportunity exists for treating underlying injury once shock is present. … Because children often maintain their blood pressure until they are severely ill, systemic hypotension … For severe sepsis, one abstractor indicated that there was a low systolic blood pressure despite the

308. Timely Antibiotics for Children With Severe Sepsis or Septic Shock (pdf file)
     www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0230-fullreport.pdf
     April 02, 2018 - Unlike adults, the diagnosis of septic shock in children does not require the presence of low blood pressure … (hypotension), as children often maintain normal blood pressure until the advanced stages of shock … A limited window of opportunity exists for therapy of the underlying injury once shock is present. … Because children often maintain their blood pressure until they are severely ill, systemic hypotension … For severe sepsis, one abstractor indicated that there was a low systolic blood pressure despite the

309. System-Focused Event Investigation and Analysis Guide | Agency for Healthcare Research and Quality
     www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide4.html
     August 01, 2022 - Resources CANDOR Family-Centered Rounds Toolkit MATCH Toolkit NICU Toolkit Pressure … Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI … The event review focuses on uncovering latent hazards or contributing factors that increase pressure

310. Chapter 1. The Framework for Improvement | Agency for Healthcare Research and Quality
     www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/vtguide/guide1.html
     February 01, 2016 - Resources CANDOR Family-Centered Rounds Toolkit MATCH Toolkit NICU Toolkit Pressure … Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI … Orthopedics, surgery, and trauma leaders. Patient safety committee.

311. Protocol for Identifying and Treating Children With Sepsis Syndrome in the Emergency Department (pdf file)
     www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-228-fullreport.pdf
     February 01, 2018 - Unlike adults, the diagnosis of septic shock in children does not require the presence of low blood pressure … (hypotension), as children often maintain normal 6 blood pressure until the advanced stages of … A limited window of opportunity exists for treating underlying injury once shock is present. … Because children often maintain their blood pressure until they are severely ill, systemic hypotension … requirement for diagnosis of septic shock in children; in fact, shock may occur long before blood pressure

312. Urine Culturing Stewardship in the ICU Setting Facilitator Notes
     www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/urine-culturing.pptx
     April 01, 2022 - Abbreviations: BP = blood pressure; GI = gastrointestinal; Hgb = hemoglobin; HR = heart rate; ICU = intensive … without evidence of another source on history, physical examination, or laboratory testing In spinal cord injury … Has the patient had recent urologic manipulation such as trauma to the GU tract or surgery? … Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients

313. Slide 1
     www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2014chartbooks/womenhealth/2014nhqdr-womenhealth.pptx
     January 01, 2020 - Importance: About 70 million American adults (29%) have high blood pressure (Nwankwo, et al., 2013). … High blood pressure costs the Nation $46 billion each year. … mostly attributable to sudden unexpected infant death (SUID), congenital anomalies, infection, and injury … Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2013). http://www.cdc.gov … /injury/wisqars/index.html .

314. Appendix A: Tools and Resources | Agency for Healthcare Research and Quality
     www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/vtguide/appa.html
     July 01, 2018 - Resources CANDOR Family-Centered Rounds Toolkit MATCH Toolkit NICU Toolkit Pressure … Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI … Regulatory measures and fiscal penalties are other pressures for optimizing VTE prevention. … The strongest work may be in high-DVT-risk trauma patients. … J Trauma Acute Care Surg 2013;74(1):128-35.) Q8.

315. Tool 2: How To Begin the Re-engineered Discharge Implementation at Your Hospital | Agency for Healthcare Research and Quality
     www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/red/toolkit/redtool2.html
     March 01, 2013 - Resources CANDOR Family-Centered Rounds Toolkit MATCH Toolkit NICU Toolkit Pressure … Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI

316. Findings From the AHRQ Transforming Primary Care Grant Initiative: A Synthesis Report (pdf file)
     www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/tpc/tpc-synthesis-report.pdf
     July 22, 2015 - post-implementation period.33 The trend applied to emergency care use overall and to asthma and unintentional injury … Specifically, the percent of PCMH patients hospitalized per month (overall and for asthma and unintentional injury … Donahue, MD, MPH Diabetes • HbA1c <9% • LDL cholesterol <100 mg/dL • Blood pressure <130/80 … ≤130/80 mm Hg • LDL cholesterol ≤100 mg/dL Cardiovascular disease: • Blood pressure ≤130/80 … Gabbay, MD, PhD Diabetes • HbA1c <7% • Blood pressure <130/80 mm Hg • LDL cholesterol <100

317. Chartbook on Women's Health Care: Slide Presentation | Agency for Healthcare Research and Quality
     www.qualitymeasures.ahrq.gov/research/findings/nhqrdr/2014chartbooks/womenhealth/womenh-slides.html
     March 01, 2020 - Importance: About 70 million American adults (29%) have high blood pressure ( Nwankwo, et al., 2013 … High blood pressure costs the Nation $46 billion each year. … mostly attributable to sudden unexpected infant death (SUID), congenital anomalies, infection, and injury … Web-based Injury Statistics Query and Reporting System (WISQARS) [Online] (2013). … http://www.cdc.gov/injury/wisqars/index.html . Accessed September 1, 2015.

318. 4. How do you implement the fall prevention program in your organization? | Agency for Healthcare Research and Quality
     www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/implementation.html
     January 01, 2013 - Resources CANDOR Family-Centered Rounds Toolkit MATCH Toolkit NICU Toolkit Pressure … Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI … Or as implementation advances and the new practices become the norm, peer pressure may spur resisters … Hospitals will not be reimbursed by Medicare for hospital-acquired falls with trauma.

319. Advancing Patient Safety | Agency for Healthcare Research and Quality
     www.qualitymeasures.ahrq.gov/patient-safety/reports/advancing/index.html
     July 01, 2022 - private-public partnerships to: (1) identify the causes of preventable health care errors and patient injury … By using hospital administrative data, PSIs can identify pressure ulcers, postoperative pulmonary emboli … Education in 2003 and that the long shifts medical interns worked led to 61 percent more needlestick injuries

320. Section 2: Engaging Stakeholders in a Care Management Program | Agency for Healthcare Research and Quality
     www.qualitymeasures.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/medicaidmgmt/mm2.html
     October 01, 2014 - Effectiveness Reviews Facilities Home and Community Resources Findings Report Injuries … management unit work with patients having a wide range of conditions (e.g., hemophilia, burns, spinal cord injury … However, local physicians' support of the program created enough pressure to reverse the decision to