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This report presents the results of a two-year study carried out under a contract with the Agency for Healthcare Research and Quality (AHRQ), which documents and analyzes the extent to which patient safety practices are being adopted by U.S. health care providers, examines hospital experiences with AHRQ's patient safety culture survey, and assesses trends in patient safety outcomes. The focus was on local initiatives to establish effective patient safety practices in the hospital, ambulatory care, and long-term care sectors. Successful implementation of these actions should lead to improved practices by providers and fewer adverse events for patients. Researchers also interviewed hospitals that use AHRQ's patient safety culture survey to learn their experiences with it. They performed case studies of patient safety activities in four communities: Indianapolis, Indiana; Cleveland, Ohio; Seattle, Washington; and Greenville, South Carolina. They also studied the dynamics of patient safety activities by hospitals in those communities and gathered information on how they adopted specific safe practices. Despite the progress observed, more work is needed to develop tools and measures for patient safety in the ambulatory care and long-term care sectors, as well as to establish a national capability to monitor changes in patient safety infrastructure, practices, and effects on a variety of involved stakeholders.

This work was sponsored by the Agency for Healthcare Research and Quality (AHRQ). The research was conducted in RAND Health, a division of the RAND Corporation.

This report is part of the RAND technical report series. RAND technical reports may include research findings on a specific topic that is limited in scope or intended for a narrow audience; present discussions of the methodology employed in research; provide literature reviews, survey instruments, modeling exercises, guidelines for practitioners and research professionals, and supporting documentation; or deliver preliminary findings. All RAND reports undergo rigorous peer review to ensure that they meet high standards for research quality and objectivity.

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