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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool4_comm_inv.docx
June 02, 2025 - Tool 4: Community Inventory
Tool 4: Community Inventory TOol
Purpose
Identify clinical, behavioral, and social service resources in the community that can improve posthospital care to reduce readmissions. The community inventory is complementary to the hospital inventory when developing a whole-person and data-info…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool5_portfolio_des.pptx
June 02, 2025 - Tool 5: Portfolio Design
Tool 5: Portfolio Design
Brief Description: A PowerPoint deck that includes examples of readmission reduction portfolios that can be modified to develop the data-informed, multifaceted “portfolio” of readmission reduction efforts in your hospital.
Purpose: To facilitate the formulation of you…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool3_hosp_inv.docx
June 02, 2025 - Tool 3: Hospital Inventory
Tool 3: Hospital Inventory Tool
Purpose
Readmission reduction efforts at your hospital have likely proliferated over the past several years, and many of these efforts may have developed in isolation from each other. The purpose of this tool is to prompt a comprehensive inventory of all r…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool6_op_dashboard.ppt
June 02, 2025 - Tool 6: Portfolio Presentation
Tool 6: Operational Dashboard
Purpose: Whatever process you put into place to reduce readmissions, measurement is the single most important tool you have to determine whether the processes you have put into place are having an impact on reducing readmissions. Develop a monthly operation…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool12_collaboration.docx
June 02, 2025 - Tool 12: Cross Continuum Collaboration Tool
Tool 12: Cross-continuum collaboration tool
Purpose
This tool helps teams develop specific effective and timely linkages to services with cross-continuum clinical, behavioral, and social services providers.
Description
Hospital readmission reduction teams need to identify…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool1_data_analysis_final.xlsx
June 02, 2025 - Tool 1: Readmission Data Analysis and Interpretation
Instructions
Tool 1. Readmission Data Analysis and Interpretation
Brief Description: A quantitative readmission analysis tool.
Purpose: Analyze hospital administrative data to evaluate readmission patterns. Understanding readmission patterns is critical to design…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool2_readm_review.docx
June 02, 2025 - Tool 2: Readmission Review Tool
Tool 2: Readmission Review tool
Purpose
Readmission reviews are designed to elicit the “story behind the story”: going well beyond chief complaint, discharge diagnosis, or other clinical parameters to understand the communication, coordination, or other logistical barriers experienc…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool11_comm_resource.docx
June 02, 2025 - transitional care planning]
[Patient-Centered Medical Home 2]
[Point person]
[XXX]
[Practice has systems
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/mcaidread_tool7_portfolio_pres.ppt
June 02, 2025 - Tool 7: Portfolio Presentation
Tool 7: Portfolio Presentation
Brief Description: PowerPoint slide deck that summarizes the findings of the quantitative and qualitative data review, hospital and community inventory, aim, target population, and data-informed strategy to reduce readmissions.
Purpose: Provides readmissio…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Prologue_Battles_Vol2.pdf
June 02, 2025 - articles addressing (1) safety and organizational issues, (2) clinical process improvement,
(3) systems … Understanding the nature of systems operating at both the overall macro level and at the micro
level … improvements at the micro
system level, the articles in section three of this volume examine redesigning systems … realization that quality and safety improvements can be made by thoughtful design
and/or redesign of our systems
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www.ahrq.gov/patient-safety/resources/simulation-issue-brief-references.html
July 01, 2024 - Use Simulation To Adopt and Adapt Best Practices
Use Simulation To Improve Healthcare Delivery Systems … Systems-focused simulation to prepare for COVID-19 intraoperative emergencies. … PEARLS for systems integration: a modified PEARLS framework for debriefing systems-focused simulations … Comprehensive Healthcare Simulation: Improving Healthcare Systems .
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www.ahrq.gov/research/findings/making-healthcare-safer/mhs3/practices.html
April 01, 2020 - Practices
Diagnostic Errors ( PDF , 2.3 MB)
Clinical Decision Support
Result Notification Systems … Education and Training
Peer Review
Failure To Rescue ( PDF , 1.8 MB)
Patient Monitoring Systems … Rapid Response Teams
Sepsis Recognition ( PDF , 2.1 MB)
Screening Tools
Patient Monitoring Systems
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www.ahrq.gov/cpi/about/nac/pcortf-snac/savitz.html
November 01, 2022 - a member of the Delivery System Science Fellowship Program Committee, co-leads the Learning Health Systems … In addition, she serves as a current board member and immediate past chair for the Health Care Systems … implementation of quality/safety interventions and realistic program evaluations that support learning health systems
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www.ahrq.gov/news/newsletters/e-newsletter/925.html
August 01, 2024 - Health Systems are now available to provide researchers, policymakers and others with a comprehensive … Study Highlights Impact of Telemedicine on Care Between 2019 and 2022, health systems in the top 25 percent … They also found that while expenditures for patient care at these systems increased by $248 per patient … each year, patients at systems that used telehealth the most reported greater adherence to both Metformin … Patient care in complex sociotechnological ecosystems and learning health systems.
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www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/hospital/healthitwebinar/sops-hit-webcast3-gandhi.pdf
January 01, 2018 - provider order entry (CPOE)
– Barcoding
– Electronic prescribing
– Handoff tools
– Test result management systems … – Referral management systems
Use of EHRs in Ambulatory Care
16.9%
21.8%
24.9%
34.8%
39.6%
48.1% … Health Affairs 2013
Optimize the use of HIT
• Need to optimize these EHR and device systems
– Reduce … • Many strategies exist to make culture change that are relevant
to HIT
– Reporting systems
– Walkrounds
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www.ahrq.gov/patient-safety/reports/candor-demo-program/candor/demo-program/index.html
August 01, 2022 - Human Services (HHS), who assigned AHRQ to establish an initiative that would help States and health systems … In addition, the initiative attempted to move toward a systems-oriented approach to learning and improvement … to 3 years for up to $3 million each were to be awarded on a competitive basis to States and health systems … up to 1 year for up to $300,000 each were to be awarded on a competitive basis to States and health systems
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www.ahrq.gov/sites/default/files/wysiwyg/data/infographics/outpatient-surgery.pdf
June 02, 2025 - Percentages below show
body systems most commonly
addressed in inpatient surgery. … Percentages below show
body systems most commonly
addressed in outpatient surgery.
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www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/tools-and-materials/key_drivers_descriptions.pdf
February 01, 2019 - Embed selected evidence and guidelines into clinical information systems
Research shows that relying … Functional clinical information systems can
make it easier for teams to adhere to agreed-upon actions … Practices that are part of larger systems may have more QI resources to draw
on and likely will need … , such as registries and laboratory systems, to fill the
gaps. … Electronic systems may require the
addition of new fields and paper-based systems will need a coherent
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Reiling.pdf
January 01, 2004 - from the health care profession and other fields, including transportation,
spacecraft design, and systems … Finally, recommendations are made for
the design of all health care systems, including new facilities … Use adaptive systems that will allow function in the future.
8. … Systems
analysis of adverse drug events. JAMA
1995;288:501–13.
3. Borden S. U.S. … Improper administration technique
harmful to patients; costly to health systems and
insurers.
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www.ahrq.gov/sites/default/files/2024-07/branscombe-report.pdf
January 01, 2024 - Inland Hospital, Waterville, Maine
Georgianna Kosciusko, Planning Office, Eastern Maine Healthcare Systems … Locally, Eastern Maine Healthcare Systems (EMHS), which is the parent corporation to the
Aroostook … Eastern Maine Healthcare
Systems employs the critical technical resources for enterprise information … systems. … The EMHS
Information Systems Department consists of over 135 highly skilled technical and analytical