… discussed safety and quality of long-term care. … Levinson DR. Washington, DC: US Department of Health and … and Human Services; Office of the Inspector General; OIG … DR … Levinson … DR Levinson …

… discussed an adverse event at a rehabilitation facility. … Levinson DR. Washington, DC: US Department of Health and Human … Human Services, Office of Inspector General; HHS; OIG … DR … Levinson … DR Levinson …

… to compounding and improved contracting processes. … Levinson DR. Washington, DC: US Department of Health and Human … and Human Services; Office of the Inspector General; OIG … DR … Levinson … DR Levinson …

… patient safety in the nursing home population. … Levinson DR. Washington, DC: US Department of Health and … OEI-06-11-00370. … Office of the Inspector General; OIG … DR … Levinson … DR Levinson …

… the adequacy of hospitals' error reporting systems. … Levinson DR. Washington, DC: US Department of Health and Human … General; January 2012. Report No. OEI-06-09-00091. … DR … Levinson … DR Levinson …

Hospitalized patients continue to suffer iatrogenic harm, according to this study of Medicare patients completed by the Office of the Inspector General (OIG). Using methodology similar to the landmark Harvard Medical Practice Study, this study found that 13.5% of hospitalized Medicare patients experienced an adverse event, of which nearly half were considered preventable. However, fewer than 2% of patients experienced either a never event or a preventable complication for which hospitals are no longer reimbursed by the Centers for Medicare and Medicaid Services. These results are similar to the OIG's prior 2008 report. Based on these results, OIG recommends further efforts to accurately measure adverse events, and also recommends broadening the "no pay for errors" policy. The challenges of accurately measuring safety problems are discussed in an AHRQ WebM&M commentary.

… recommendations to improve screening for adverse events. … Levinson DR. Washington, DC: US Department of Health and Human … General; March 2010. Report No. OEI-06-08-00221. … DR … Levinson … DR Levinson …

… a condition on CMS's no pay for errors list.  … Levinson DR. Washington, DC: US Department of Health and … General; December 2008. Report No. OEI-06-08-00220. … DR … Levinson … DR Levinson …

… of state reporting systems in advancing patient safety. … Levinson DR. Washington, DC: US Department of Health and Human … General; December 2008. Report No. OEI-06-07-00471. … DR … Levinson … DR Levinson …

The Tax Relief and Health Care Act of 2006 mandated that the Office of Inspector General (OIG) report to Congress the incidence of "never events" among Medicare beneficiaries, payment by Medicare for services in connection with such events, and the process used to identify events and deny payments. This report addresses that mandate by providing a descriptive analysis of the key issues to understanding hospital-based adverse events. The report is focused around discussion of seven critical issues that are explored in detail. Of note, OIG expanded the study of never events to the broader topic of adverse events in their analysis.

This report examines the operation and staffing of 109 physician-owned specialty hospitals and identifies shortcomings in the availability of emergency services.