<h3>Context</h3>Currently most automated methods to identify patient safety occurrences rely on administrative data codes; however, free-text searches of electronic medical records could represent an additional surveillance approach.<h3>Objective</h3>To evaluate a natural language processing search–approach postoperative surgical complications within comprehensive record.<h3>Design, Setting, and Patients</h3>Cross-sectional study involving 2974 patients undergoing inpatient procedures at 6...

The Accreditation Council for Graduate Medical Education (ACGME) implemented duty hour regulations physicians-in-training throughout the United States on July 1, 2003. association of reform with mortality among patients in teaching hospitals nationally has not been well established.To determine whether change was associated relative changes Medicare different intensity.An observational study all unique (N = 8 529 595) admitted to short-term, acute-care, general US nonfederal 3321) using...

Objectives: Use of failure-to-rescue (FTR) as an indicator hospital quality has increased over the past decade, but recent authors have used different sets complications and deaths to define this measure. This study examines reliability validity FTR measures currently in use. Research Design: We studied 3 definitions: (1) "original" (using all deaths); (2) FTR-N, a "nursing sensitive" definition that uses only specific deaths; (3) FTR-A [another restricted by Agency for Healthcare Quality...

Objective. To describe the development of an instrument for assessing workforce perceptions hospital safety culture and to assess its reliability validity. Data Sources/Study Setting. Primary data collected between March 2004 May 2005. Personnel from 105 U.S. hospitals completed a 38‐item paper pencil survey. We received 21,496 questionnaires, representing 51 percent response rate. Study Design. Based on review existing climate surveys, we developed list key topics pertinent maintaining in...

Background: Safety climate refers to shared perceptions of what an organization is like with regard safety, whereas safety culture employees' fundamental ideology and orientation explains why pursued in the manner exhibited within a particular organization. Although research has sought identify opportunities for improving outcomes by studying patterns variation climate, few empirical studies have examined impact organizational characteristics such as on hospital climate. Purpose: This study...

To examine the criterion validity of Agency for Health Care Research and Quality (AHRQ) Patient Safety Indicators (PSIs) using clinical data from Veterans Administration (VA) National Surgical Improvement Program (NSQIP).Fifty five thousand seven hundred fifty two matched hospitalizations 2001 VA inpatient surgical discharge NSQIP chart-abstracted data.We examined sensitivities, specificities, positive predictive values (PPVs), likelihood ratios PSIs that corresponded to adverse events. We...

Policy Points: Composite measures of health care provider performance aggregate individual into an overall score, thus providing a useful summary performance. Numerous federal, state, and private organizations are adopting composite for profiling pay‐for‐performance programs. This article makes important contribution to the literature by highlighting advantages disadvantages different approaches creating also summarizing key issues related use various methods. complement when incentives...

Personal health records (PHRs) have the potential to improve patient self-management for chronic conditions such as diabetes. However, evidence is mixed whether there an association between PHR use and improved outcomes.The aim of this study was evaluate sustained specific portal features (Web-based prescription refill secure messaging-SM) physiological measures important management type 2 diabetes.Using a retrospective cohort design, including Veterans with diabetes registered My Health e...

Improving safety climate could enhance patient safety, yet little evidence exists regarding the relationship between hospital characteristics and climate. This study assessed hospitals' organizational culture in Veterans Health Administration (VA) hospitals nationally. Data were collected from a sample of employees stratified random 30 VA over 6-month period (response rate = 50%; n 4,625). The Patient Safety Climate Healthcare Organizations (PSCHO) Zammuto Krakower surveys used to measure...

The Patient Safety Indicators (PSIs), an administrative data-based tool developed by the Agency for Healthcare Research and Quality, are increasingly being used to screen potential in-hospital patient safety problems. Although Veterans Health Administration (VA) is a national leader in safety, accurate information on epidemiology of events VA still unavailable.Our objectives were to: (1) apply AHRQ PSI software data identify instances compromised safety; (2) determine occurrence rates VA;...

<h3>Objectives</h3> To determine if the lower mortality often observed in teaching-intensive hospitals is because of complication rates or death after complications (failure to rescue) and whether benefits at these accrue equally white black patients, since patients receive a disproportionate share their care hospitals. <h3>Design</h3> A retrospective study patient outcomes teaching intensity using logistic regression models, with without adjusting for hospital fixed random effects....

Background. Guideline-based depression process measures provide a powerful way to monitor care and target areas needing improvement. Objectives. To assess the adequacy of in Veterans Health Administration (VHA) using guideline-based derived from administrative centralized pharmacy records, identify patient provider characteristics associated with adequate care. Research Design. This is cohort study patients 14 VHA hospitals Northeastern United States which relied on existing databases....

The authors estimated the impact of potentially preventable patient safety events, identi- fied by Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs), on outcomes: mortality, length stay (LOS), cost. PSIs were applied to all acute inpatient hospitalizations at Veterans Health Administration (VA) facil- ities in fiscal 2001. Two methods—regression analysis multivariable case matching— used independently control facility characteristics while predicting effect...

A random sample of employees was surveyed 20 months after a non-smoking policy implemented at the New England Telephone Company in 1986. Overall, 21 percent respondents who were smoking time they heard about had quit smoking; 42 quitters said stopped because policy. Cessation highest among those reported less smoke their work area, but not related to participation cessation programs. This study suggests that worksite nonsmoking policies may have favorable effects on cessation.

The risks of transfusion‐associated infectious disease have led to a reassessment transfusion practice, which in turn has resulted trend toward the reduction homologous transfusion. This is primarily due initiation hemotherapy at more severe levels anemia. optimum threshold for therapy, or trigger (TT), unknown. purpose this study evaluate effects withholding lowering TT hematocrit (Hct) 15 percent unanesthetized animals. Nineteen adult baboons underwent laparotomy simulate surgical stress....

Background: In-hospital mortality measures such as the Agency for Healthcare Research and Quality (AHRQ) Inpatient Indicators (IQIs) are easily derived using hospital discharge abstracts publicly available software. However, assessments based on a 30-day postadmission interval might be more accurate given potential differences in facility practices. Objectives: To compare in-hospital rates 6 medical conditions AHRQ IQI Methods: We used software (v3.1) 2004–2007 Veterans Health Administration...

Objective: Improving patient safety was a strong motivation behind duty hour regulations implemented by Accreditation Council for Graduate Medical Education on July 1, 2003. We investigated whether rates of indicators (PSIs) changed after these reforms. Research Design: Observational study patients admitted to Veterans Health Administration (VA) (N = 826,047) and Medicare 13,367,273) acute-care hospitals from 2000 June 30, 2005. examined changes in events more versus less teaching-intensive...

To assess variation in safety climate across VA hospitals nationally.

Background: The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) use administrative data to detect potentially preventable in-hospital adverse events. However, few studies have determined how accurately the PSIs identify true safety Objectives: We examined criterion validity, specifically positive predictive value (PPV), of 12 selected using clinical abstracted from Veterans Health Administration (VA) electronic medical record as gold standard. Methods:...