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141. Diagnostic Safety Grants Awarded in FY 2019 | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/diagnostic-safety/research/grants-2019.html
     March 01, 2024 - patient-centered framework co-designed with patients/families and care partners to measure and categorize patient-reported … apply this new analytic tool to establish the incidence, types, and contributing factors to patient-reported … use and impact of this method on the diagnostic process measuring safety (incidence/types of patient-reported

142. Spotlight on Pennsylvania -- The National Evaluation of the CHIPRA Quality Demonstration Grant Program (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/chipra-750-pennsylvania-state-snapshot.pdf
     January 01, 2018 - CHOP used demonstration funding to enhance and expand a pre-existing screening project and reported … The health systems reported that EHR limitations and competing organizational priorities posed challenges … With this support and their own resources, the health systems— • Reported on 10 to 18 Child Core Set … January 2018 Spotlight on Pennsylvania reporting; as such, health systems reported quality measures … • Continue efforts to improve performance on Child Core Set measures, though health systems reported

143. Hospital Survey on Patient Safety Culture: Background and Information for Translators (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/resources/infotranshsops.pdf
     September 01, 2009 - When a mistake is made, but has no potential to harm the patient, how often is this reported? D3. … When a mistake is made that could harm the patient, but does not, how often is this reported? … When an event is reported, it feels like the person is being written up, not the problem. … Number of Events Reported (No event reports, 1 to 2 event reports, 3 to 5 event reports, 6 to 10 … Frequency of Events Reported 9. Teamwork Across Units 10. Staffing 11.

144. Pediatric Medical Complexity Algorithm (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-141-fullreport.pdf
     July 01, 2017 - In Use: Have measure results been reported at this level previously? No. … In Use: Have measure results been reported at this level previously? No. … In Use: Have measure results been reported at this level previously? Yes. … In Use: Have measure results been reported at this level previously? Yes. … In Use: Have measure results been reported at this level previously? No.

145. Appendix A. Recommendations for Ideal Consumer Reporting Systems (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/hotline/hotline-appendixa.pdf
     May 11, 2016 - where a patient safety event occurred; what contributed to the event; whether or to whom the event was reported … ; what happened when the event was reported; and the impacts or consequences of the event. … To be accountable to consumers providing reports means that reported information will be actively used … linkages to a broad range of organizations that can change health care practices and demonstrate that reported

146. Section 7.A, Appendix 7, Race and Ethnicity Stratification (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/duration/chipra-153-section-7a-appendix-7.pdf
     June 30, 2009 - 0.6299 (0.6241,0.6357) 18552 *Note Informed Coverage includes Medicaid, M-CHIP, and S-CHIP (when reported … Among the states above, New York alone does not report enrollment for all programs; NY S-CHIP is not reported

147. Candidate Measure Submission Form (CPCF) | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/policymakers/chipra/cpcf-form9.html
     December 01, 2013 - Levels of Aggregation CHIPRA states that data used in quality measures must be collected and reported … If there is no information about whether the measure could be meaningfully reported at a specific level … In Use: Have measure results been reported at this level previously? … Reliability & Validity: Is there published evidence about the reliability and validity of the measure when reported

148. Fallpxtool1A (doc file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallpxtoolkit/fallpxtool1a.docx
     January 01, 2004 - When an event is reported, it feels like the person is being written up, not the problem 1 2 3 4 … ask questions when something does not seem right 1 2 3 4 5 SECTION D: Frequency of Events Reported … In your hospital work area/unit, when the following mistakes happen, how often are they reported? … When a mistake is made, but has no potential to harm the patient, how often is this reported? … When a mistake is made that could harm the patient, but does not, how often is this reported?

149. Surveys on Patient Safety Culture (SOPS) Hospital 1.0 Survey: 2021 User Database Report Part I (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/hsops1-database-report-part-I.pdf
     March 01, 2021 - Frequency of events reported Mistakes of the following types are reported: (1) mistakes caught and corrected … Table 6-4 presents statistics for the number of events reported. … before affecting the patient, how often is this reported? … Frequency of Events Reported 68% 68% 0% 21% -15% 5% -4% 7. … before affecting the patient, how often is this reported?

150. Register Now: April 25 Webinar Will Launch HHS Series on National Action Alliance To Advance Patient Safety | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/news/newsletters/e-newsletter/858.html
     April 01, 2023 - Nurse Staffing Gaps Reported in Hospitals With More Vulnerable Maternity Patients, Study Finds . … Nurse Staffing Gaps Reported in Hospitals With More Vulnerable Maternity Patients, Study Finds Most … hospitals adhere to nurse staffing guidelines, but gaps in staffing are reported more frequently at … They found that nurses reported strong adherence to staffing guidelines in their hospitals; but higher … They concluded that gaps in staffing were reported more frequently at hospitals serving the most vulnerable

151. Do Transient Working Conditions Trigger Medical Errors? (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Grayson.pdf
     January 01, 2003 - Results: Subjects were more likely to describe their work environment as more hectic and reported increased … Of the errors that subjects reported to us, 91 percent were related to medication administration and … Twelve percent of subjects reported that their working environment was less hectic in the 30 minutes … Fifty-eight percent of subjects reported that there were no differences in this variable between the … As reported by Eagle et al.,20 our study suggests that lack of important information contributes to

152. How Does the NPSD Work? | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/npsd/how-does-npsd-work/index.html
     February 01, 2024 - Only data for CFER-H have been reported to the PSOPPC/NPSD; therefore, they are the only source of data … NPSD Data Are Unique The data presented by the NPSD differ from clinical quality measures reported … Clinical quality measures reported by other agencies typically focus on all eligible members of the population

153. Surveys on Patient Safety Culture (SOPS) Hospital 2.0 Survey: 2022 User Database Report Part II (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/2022-hsops2-database-report-appendixes.pdf
     January 01, 2022 - Highlights were based on results for the 10 SOPS composite measures, number of events reported, and … • Investor owned hospitals had the highest average percentage of respondents who reported one or … • West North Central hospitals had the highest average percentage of respondents who reported one … • Telemetry had the highest average percentage of respondents who reported one or more events in … (Item A6*) 58% 63% 61% 61% 60% When an event is reported in this unit, it feels like the person is

154. The AAFP Patient Safety Reporting System: Development and Legal Issues Pertinent to Medical Error Tracking and Analysis (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Phillips.pdf
     January 01, 2004 - Forty-two physicians reported 343 incidents over 10 weeks. … Nine of the reported errors Advances in Patient Safety: Vol. 3 124 Table 1. … Errors in the first two studies were reported only by physicians, but errors in the third study were … reported by physicians, staffs, and patients. … Most coding to date has focused on the primary error being reported.

155. Impact of Staff-Led Safety Walk Rounds (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Montgomery_42.pdf
     March 05, 2008 - Climate Survey before executive walk rounds began and again 2 months after they ended.2 The authors reported … In addition, the committee reported the results of safety walk rounds to other hospital committees and … Issues that were reported and resolved include: 3 • Chemotherapy for different patients with … Twenty-eight different safe habits have been reported in response to the question, “Have you developed … Grillo reported that 30 percent of the comments reported during their safety walk rounds related to

156. II. Hotline Design and Development | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/patient-safety/reports/hotline/design2.html
     May 01, 2016 - information to enable followup with both the patient and providers who may have been involved in the reported … Our primary concerns were the clarity of the questions, their face validity, and the frequency of reported … We selected response items that we believed to be most commonly encountered and reported. … The Web interface captures the details of patient-reported safety events. … The patient- and caregiver-reported information held by the hotline is kept in a database separate from

157. Spotlight on West Virginia -- The National Evaluation of the CHIPRA Quality Demonstration Grant Program (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/statesummaries/chipra-750-west-virginia-state-snapshot.pdf
     January 01, 2018 - were recognized as PCMHs by the National Committee for Quality Assurance (NCQA); the other practices reported … the average Medical Home Index score for participating practices in West Virginia Note: Data were reported … The reports compared each practice’s performance on reported measures with those of other practices … Two practices reported improvements in all immunization rates for 2-year-olds except for rotavirus … These practices also reported higher rates of immunizations for adolescents.

158. Postpartum Followup and Care Coordination (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/perinatal/chipra-0084-fullreport.pdf
     March 01, 2016 - In Use: Have measure results been reported at this level previously? No. … In Use: Have measure results been reported at this level previously? No. … In Use: Have measure results been reported at this level previously? No. … In Use: Have measure results been reported at this level previously? No. … In Use: Have measure results been reported at this level previously? No.

159. Lessons in Safety Climate and Safety Practices from a California Hospital Consortium (pdf file)
     ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Singer.pdf
     April 01, 2003 - Hospitals reported a range and mix of patient safety activities. … However, participating hospitals reported no substantial change in the ratio of reported-to-measured … This facility reported that huddles have been an effective means of communicating quickly. … Several consortium hospitals reported falling into this trap at some point in time. … Rather, participating hospitals reported and shared ongoing initiatives to improve safety.

160. Hospital Survey Version 2.0: Background and Information for Translators | Agency for Healthcare Research and Quality
     ce.effectivehealthcare.ahrq.gov/sops/international/hospital/translators-version-2.html
     September 01, 2023 - When an event is reported in this unit, it feels like the person is being written up, not the problem … (negatively worded) More about this item: When an event is reported, it feels like the person is the … When a mistake is caught and corrected before reaching the patient, how often is this reported? … Number of Events Reported (None, 1 to 2, 3 to 5, 6 to 10, 11 or more) D3.  … In the past 12 months, how many patient safety events have you reported?