- 
                                        
effectivehealthcare.ahrq.gov/sites/default/files/related_files/mhs-IV-1-year-final-report-updated-title_0.pdf
May 01, 2024 - judged to be preventable.9 The leading types of harm found in the OIG 
report (i.e., medication errors, pressure … ulcers, surgical procedural errors, and infections) align 
with the topics in the initial MHS report … hygiene 
• “Do Not Use” list for hazardous abbreviations 
• Multicomponent interventions to reduce pressure … ulcers 
• Barrier precautions to prevent healthcare-associated 
infections 
• Use of real-time ultrasound
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Scanlon_62.pdf
March 25, 2008 - For instance, if an injury-based metric identifies a falsely high rate of 
decubitus ulcers at a hospital
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2018qdr-datasources.pdf
October 01, 2019 - ulcers. … events associated with the hospital stay and not present on hospital admission 
(in-hospital falls and pressure … ulcers). … After Cardiac 
Surgery 
Postoperative Cardiac Event After Non-cardiac 
Surgery  
Hospital-Acquired Pressure … Ulcer  General  2004-2007 and 2009-2016 
Adverse Events Associated With Femoral Artery 
Puncture for
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-143-fullreport.pdf
April 01, 2018 - reasonably” preventable hospital-acquired conditions—such as 
hospital-acquired urinary tract infections and pressure … ulcers—that qualify for reduced 
reimbursement (CMS, 2007). … : "Naloxone administration," “Health care-
associated infections: positive C. difficile test,” and "Pressure … ulcer documentation."
                                     
                                                                    - 
                                        
www.uspreventiveservicestaskforce.org/home/getfilebytoken/wBcZfBcVp8N3-cyT3Peysv
April 01, 2016 - Aspirin for the Primary Prevention of Cardiovascular Events: A Systematic Evidence Review for the USPSTF
Aspirin for the Primary Prevention of Cardiovascular Events:
A Systematic Evidence Review for the U.S. Preventive Services
Task Force
Janelle M. Guirguis-Blake, MD; Corinne V. Evans, MPP; Caitlyn A. Senger, MPH; E… 
                                     
                                                                    - 
                                        
www.ahrq.gov/hai/cauti-tools/archived-webinars/engaging-nurse-physician-patient-transcript.html
December 01, 2017 - We've expanded to better chucks, putting in chucks that wick, because we also work with the pressure … ulcer department, our walk nurses to reduce those, and make sure that that wasn't going to affect them
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/engaging-nurse-physician-patient-transcript.docx
June 02, 2025 - We've expanded to better chucks, putting in chucks that wick, because we also work with the pressure … ulcer department, our walk nurses to reduce those, and make sure that that wasn't going to affect them
                                     
                                                                    - 
                                        
effectivehealthcare.ahrq.gov/sites/default/files/related_files/atrial-fibrillation-ablation_surveillance.pdf
May 16, 2013 - Source: www.effectivehealthcare.ahrq.gov 
Published online: May 16, 2013 
	
  
 
CER # 15: 
Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation 
 
Original release date 
July 6, 2009 
 
Surveillance Report (1st Assessment/cycle 1) 
November, 2011 
 
Surveillance Report (2nd Assessment/cycle 2)… 
                                     
                                                                    - 
                                        
hcup-us.ahrq.gov/db/nation/nis/APS-DRGs%20V22%20Definitions%20Manual.pdf
April 01, 2006 - ___APS-Def_Public.book
2 3 2 1  W h i t n e y  A v e n u e  •  H a m d e n ,  C T  0 6 5 1 8  •  1 - 8 0 0 - 9 9 9 - 3 7 4 7
D e f i n i t i o n s  M a n u a l
APS-DRGs
ALL-PAYER SEVERITY-ADJUSTED DRG 
(APS-DRGS®) ASSIGNMENT 
FOR PUBLIC USE 
VERSION 22
®
PUB 4.5.2006
COPYRIGHT PAGE
Copyright © 2006 HSS Inc.
A… 
                                     
                                                                    - 
                                        
effectivehealthcare.ahrq.gov/sites/default/files/pdf/horizon-scan_research-2015.pdf
January 01, 2015 - pose a risk of falls for elderly 
patients, narrow and thin mattresses increase the risk of developing pressure … ulcers, 
fluorescent lights and a lack of windows foster disorientation in cognitively impaired older
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Emanuel_19.pdf
February 20, 2008 - rapid response teams, ICU, ER, etc 
 Module 11 Breakout session Chronic care settings: palliative care, pressure … ulcers, falls, etc 
 Module 12 Breakout session Interventional care settings: surgical care; infection
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2022qdr-appendix-combined.pdf
October 25, 2022 - injury to neonate per 1,000 live births HCUP 2019 
High-risk, long-stay nursing home patients with pressure … ulcer MDS 2019 
Low-risk, long-stay nursing home residents with a catheter inserted 
and left in the … ulcers that are new 
or worsened MDS 2018 
Adults who reported a home health care provider talking with … ulcer MDS 2019 
Low-risk, long-stay nursing home residents with a catheter inserted 
and left in the … ulcers that are new or 
worsened MDS 2018 
Adults who reported a home health care provider talking with
                                     
                                                                    - 
                                        
psnet.ahrq.gov/web-mm/risks-malpositioned-gastrostomy-tube-and-poor-communication
August 01, 2012 - SPOTLIGHT CASE
         
 The Risks of a Malpositioned Gastrostomy Tube and Poor Communication 
 
 
 
 
 Citation Text: 
 Hight RA. The Risks of a Malpositioned Gastrostomy Tube and Poor Communication. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Servic… 
                                     
                                                                    - 
                                        
www.uspreventiveservicestaskforce.org/home/getfilebytoken/2GDCmTe7akyrAHsTMbfz72
May 06, 2022 - Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Updated Evidence Report and Systematic Review for the USPSTF
Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer
Updated Evidence Report and Systematic Review
for the US Preventive Services Task Force
Janelle M. Guirguis-Blake, MD; C… 
                                     
                                                                    - 
                                        
effectivehealthcare.ahrq.gov/sites/default/files/vte-protocol-8-4-10.pdf
February 01, 2008 - Evidence Report on the 
 
Source: www.effectivehealthcare.ahrq.gov  
Published Online: August 06, 2010 
 
Evidence-based Practice Center Systematic Review Protocol 
Project Title: Comparative Effectiveness of Venous 
Thromboembolism (VTE) Prophylaxis in Orthopedic Surgery 
I.   Background and Objectives for the … 
                                     
                                                                    - 
                                        
effectivehealthcare.ahrq.gov/sites/default/files/pdf/blood-clots-hip-knee-surgery_research-protocol.pdf
February 01, 2008 - Evidence Report on the 
 
Source: www.effectivehealthcare.ahrq.gov  
Published Online: August 06, 2010 
 
Evidence-based Practice Center Systematic Review Protocol 
Project Title: Comparative Effectiveness of Venous 
Thromboembolism (VTE) Prophylaxis in Orthopedic Surgery 
I.   Background and Objectives for the … 
                                     
                                                                    - 
                                        
hcup-us.ahrq.gov/reports/methods/2020-04.pdf
January 01, 2020 - PSI03 Admissions with pressure ulcers per 1,000 
medical and surgical discharges of length 3 or 
more … days,a,b age18 and over 
a The AHRQ PSI software requires that the pressure ulcers be reported 
as … the AHRQ PSI software, the 
following cases are excluded: admissions with a principal diagnosis of 
pressure … ulcer stage III or IV or unstageable; admissions involving 
severe burns or exfoliative disorders; obstetric
                                     
                                                                    - 
                                        
www.ahrq.gov/sites/default/files/2025-02/peterson-report.pdf
January 01, 2025 - that a significantly higher number of patients in the MRSA group had an 
indwelling device (p<0.001), pressure … ulcer (p=0.028), or diabetes mellitus (p=0.007), there were 
no differences in the primary infection
                                     
                                                                    - 
                                        
psnet.ahrq.gov/perspective/artificial-intelligence-and-patient-safety-promise-and-challenges
March 27, 2024 - likelihood that a patient will  decompensate , have an adverse reaction to a medication, or develop a pressure … ulcer and then alerting clinicians if the risk is high enough.
                                     
                                                                    - 
                                        
psnet.ahrq.gov/perspective/conversation-withpatrick-tighe-about-artificial-intelligence
March 27, 2024 - likelihood that a patient will  decompensate , have an adverse reaction to a medication, or develop a pressure … ulcer and then alerting clinicians if the risk is high enough.