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| 1. |  Study: Mortality among hospitalized Medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. |
| | Volpp KG, Rosen AK, Rosenbaum PR, et al. JAMA. 2007;298:975-983. |
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| 2. | Study: Mortality among patients in VA hospitals in the first 2 years following ACGME resident duty hour reform. |
| | Volpp KG, Rosen AK, Rosenbaum PR, et al. JAMA. 2007;298:984-992. |
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| 3. | Study: Video capture of clinical care to enhance patient safety. |
| | Weinger MB, Gonzales DC, Slagle J, Syeed M. Qual Saf Health Care. 2004;13:136-144. |
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| 4. | Study: Discussion of medical errors in morbidity and mortality conferences. |
| | Pierluissi E, Fischer MA, Campbell AR, Landefeld CS. JAMA. 2003;290:2838-2842. |
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| 5. | Study: Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. |
| | Jha AK, Perlin JB, Kizer KW, Dudley RA. N Engl J Med. 2003;348:2218-2227. |
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| 6. | Commentary: Making the business case for patient safety. |
| | Weeks WB, Bagian JP. Jt Comm J Qual Safety. 2003;29:51-54. |
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| 7. | Study: Diagnostic error in internal medicine. |
| | Graber ML, Franklin N, Gordon R. Arch Intern Med. 2005;165:1493-1499. |
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| 8. | Study: The Veterans Affairs root cause analysis system in action. |
| | Bagian JP, Gosbee J, Lee CZ, Williams L, McKnight SD, Mannos DM. Jt Comm J Qual Improv. 2002;28:531-545. |
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| 9. | Study: Are bad outcomes from questionable clinical decisions preventable medical errors? A case of cascade iatrogenesis. |
| | Hofer TP, Hayward RA. Ann Intern Med. 2002;137(pt 1):327-333. |
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| 10. | Study: Using health care Failure Mode and Effect Analysis: the VA National Center for Patient Safety's prospective risk analysis system. |
| | DeRosier J, Stalhandske E, Bagian JP, Nudell T. Jt Comm J Qual Improv. 2002;28:248-267, 209. |
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| 11. | Study: Sleep deprivation and clinical performance. |
| | Weinger MB, Ancoli-Israel S. JAMA. 2002;287:955-957. |
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| 12. | Study: Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer. |
| | Hayward RA, Hofer TP. JAMA. 2001;286:415-420. |
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| 13. | Study: Risk management: extreme honesty may be the best policy. |
| | Kraman SS, Hamm G. Ann Intern Med. 1999;131:963-967. |
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| 14. | Commentary: Avoiding the unintended consequences of growth in medical care: how might more be worse? |
| | Fisher ES, Welch HG. JAMA. 1999;281:446-453. |
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| 15. | Study: Do house officers learn from their mistakes? |
| | Wu AW, Folkman S, McPhee SJ, Lo B. JAMA. 1991;265:2089-2094. |
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| 16. | Commentary: Building physician work hour regulations from first principles and best evidence. |
| | Volpp KG, Landrigan CP. JAMA. 2008;300:1197-1199. |
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| 17. | Study: Inpatient suicide and suicide attempts in Veterans Affairs hospitals. |
| | Mills PD, DeRosier JM, Ballot BA, Shepherd M, Bagian JP. Jt Comm J Qual Patient Saf. 2008;34:482-488. |
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| 18. | Study: Older patients' perceptions of "unnecessary" tests and referrals: a national survey of Medicare beneficiaries. |
| | Herndon MB, Schwartz LM, Woloshin S, et al. J Gen Intern Med. 2008;23:1547-1554. |
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| 19. | Study: Recruitment of hospitals for a safety climate study: facilitators and barriers. |
| | Rosen AK, Gaba DM, Meterko M, et al. Jt Comm J Qual Patient Saf. 2008;34:275-284. |
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| 20. | Study: An overview of patient safety climate in the VA. |
| | Hartmann CW, Rosen AK, Meterko M, et al. Health Serv Res. 2008;43:1263-1284. |
