Assessing Patient Safety Practices and Outcomes in the U.S. Health Care System

Assessing Patient Safety Practices and Outcomes in the U.S. Health Care System

Assessing Patient Safety Practices and Outcomes in the U.S. Health Care System

Assessing Patient Safety Practices and Outcomes in the U.S. Health Care System


Presents the results of a two-year study that analyzes how patient safety practices are being adopted by U.S. health care providers, examines hospital experiences with a patient safety culture survey, and assesses patient safety outcomes trends. In case studies of four U.S. communities, researchers collected information on the dynamics of local patient safety activities and on adoption of safe practices by hospitals.


In 2000, the U.S. Congress mandated the Agency for Healthcare Research and Quality (AHRQ) to take a leadership role in helping health care providers reduce medical errors and improve patient safety. AHRQ is fulfilling that mandate through a patient safety research and development initiative, which is now at the end of its fourth year of operation. In September 2002, AHRQ contracted with RAND to serve as the patient safety evaluation center for this initiative. The evaluation center has been responsible for performing a four-year formative evaluation of the full scope of AHRQ’s patient safety activities, and providing regular feedback to support the continuing improvement of the initiative over the evaluation period. The contract also includes a two-year option for analysis of the diffusion of safe practices in the health care system, which RAND performed in October 2006 through September 2008.

This report presents the results RAND’s work under the two-year contract option, to assess practice adoption by health care providers and related outcomes. The assessments encompass three analytic components that address different aspects of practice adoption and diffusion across the country. Community studies were conducted of patient safety practice adoption and related activities that qualitatively examined the extent of use of safe practices at the community level, and the experiences of hospitals that used the AHRQ Hospital Survey on Patient Safety Culture (HSOPS) were examined. Finally, recognizing the need for capability to assess practice use quantitatively, a questionnaire was developed to use in a national survey of hospitals to gather data on their adoption of the safe practices endorsed by the National Quality Forum. In addition, this report presents the most recent results from our continued analysis of trends in patient outcomes related to safety.

The contents of this report will be of primary interest to AHRQ, but should also be of interest to national and state policy makers, health care organizations, health researchers, and others with responsibilities for ensuring that patients are not harmed by the health care they receive.

This work was sponsored by the Agency for Healthcare Research and Quality, Department of Health and Human Services, for which James B. Battles, Ph.D. serves as project officer.

This work was conducted in RAND Health, a division of the RAND Corporation. A profile of RAND Health, abstracts of its publications, and ordering information can be found at

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