Adverse events in hospitals: National incidence among medicare beneficiaries

The U.S. Department of Health and Human Services, Office of the Inspector General (OIG) is completing a series of reports regarding adverse events in hospitals. Congress mandated in 2006 that the OIG study the incidence of adverse events among hospitalized Medicare beneficiaries and associated Medicare costs. OIG released four reports between 2008 – 2009 and will release two additional reports prior to the APHA conference in November 2010. Topics include incident reporting systems, nonpayment policies, and public disclosure of event information. We propose presenting the centerpiece study of the series, which will be publicly reported in March 2010. This report establishes a national incidence rate for adverse events among hospitalized Medicare beneficiaries based on a physician medical record review. OIG selected a random sample of Medicare beneficiaries hospitalized in October 2008. Nurses and medical coders reviewed the medical records and claims for all sample beneficiaries then a panel of physician experts conducted a full medical record review for cases suspected to contain an adverse event. The physician panel was comprised of five experts in patient safety, including an infectious disease specialist, cardiologist, surgeon, internist, and cardiologist. In addition to providing an incidence rate for adverse events, the study details the nature of the events, an assessment of the extent to which they were preventable, and the resulting costs to Medicare. The occurrences found by the study include temporary harm events (such as delirium as a result of medication), events that prolonged hospitalization (such as catheter-associated urinary tract infections) and serious events resulting in permanent disability or death. The report represents the first effort to provide a national incidence rate for adverse events since the release of the IOM's To Err is Human Report, as well as the first effort to measure the effect of Medicare's Hospital-Acquired Condition nonpayment policy.