CMC Quality Assurance & Improvement 5 — Questions and Answers
Question 1: A hospital aims to improve equity in cardiac care. Which of the following best represents an equity-focused quality measure?
- Stratifying 30-day AMI readmission rates by race, ethnicity, and insurance status to identify disparities (Correct answer)
- Achieving an average door-to-balloon time of 75 minutes across all patients
- Increasing overall beta-blocker prescription rates to 95%
- Reducing total cardiac surgery costs by 10% over two years
Correct answer: Stratifying 30-day AMI readmission rates by race, ethnicity, and insurance status to identify disparities
Equity measures require disaggregating outcome data by demographic subgroups to identify and address disparities in care quality across different patient populations.
Question 2: In a cardiac quality review, a near-miss event is identified where a heparin infusion was nearly given to the wrong patient. What is the most appropriate response?
- Report the near-miss in a non-punitive incident reporting system and conduct a root cause analysis (Correct answer)
- Counsel the nurse involved and document the incident in their personnel file
- Increase heparin dosing oversight only for that specific nurse
- Treat it as a resolved issue since no patient was harmed
Correct answer: Report the near-miss in a non-punitive incident reporting system and conduct a root cause analysis
Near-miss events should be reported non-punitively and analyzed for systemic vulnerabilities — they represent valuable learning opportunities before actual harm occurs.
Question 3: Which of the following best describes the concept of 'high reliability' in cardiac care organizations?
- Maintaining consistently safe operations despite high complexity and the constant potential for error (Correct answer)
- Achieving 100% patient satisfaction scores over a consecutive 12-month period
- Having zero cardiac surgery cancellations due to equipment failure
- Ensuring all staff complete annual competency training requirements
Correct answer: Maintaining consistently safe operations despite high complexity and the constant potential for error
High reliability organizations (HROs) consistently minimize errors and adverse events in complex, high-risk environments through system-level strategies like sensitivity to operations and deference to expertise.
Question 4: A cath lab team is using time-series data to evaluate whether a new pre-hydration protocol reduced contrast-induced nephropathy rates. Which chart is most appropriate?
- Run chart showing nephropathy rates plotted over time before and after protocol implementation (Correct answer)
- Pie chart showing proportion of patients with vs. without nephropathy
- Bar chart comparing two time points only (pre and post)
- Histogram showing distribution of creatinine values at discharge
Correct answer: Run chart showing nephropathy rates plotted over time before and after protocol implementation
A run chart displays data over time and helps teams visualize trends and the effect of interventions, making it the best tool for before-and-after quality improvement evaluation.
Question 5: Which of the following CMS programs penalizes hospitals financially for excess risk-adjusted 30-day readmission rates in heart failure?
- Hospital Readmissions Reduction Program (HRRP) (Correct answer)
- Value-Based Purchasing Program (VBP)
- Hospital-Acquired Condition Reduction Program (HACRP)
- Merit-based Incentive Payment System (MIPS)
Correct answer: Hospital Readmissions Reduction Program (HRRP)
The HRRP, established by the ACA, reduces Medicare payments to hospitals with excess readmissions for conditions including heart failure, AMI, and pneumonia.
Question 6: During a cardiac QI project, the team discovers that improvements are sustained during the project but revert after the project team disbands. Which strategy best addresses this sustainability failure?
- Hardwire the change into standard protocols, order sets, and electronic health record workflows (Correct answer)
- Repeat the PDSA cycle indefinitely with the same project team
- Report the failure to hospital administration and request additional funding
- Increase staff education sessions about the importance of the change
Correct answer: Hardwire the change into standard protocols, order sets, and electronic health record workflows
Embedding changes into default order sets, clinical pathways, and EHR workflows (hardwiring) removes reliance on individual memory or motivation, ensuring sustained practice change.
Question 7: A cardiac program is evaluating patient experience as part of its quality dashboard. Which standardized survey tool is used to measure inpatient cardiac patient experience for public reporting?
- Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) (Correct answer)
- Press Ganey Physician Satisfaction Survey
- CAHPS Clinician and Group Survey
- Picker Patient Experience Questionnaire
Correct answer: Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
HCAHPS is the standardized, publicly reported national survey for measuring inpatient patient experience, including domains relevant to cardiac care such as communication and discharge information.
CMC Quality Assurance & Improvement 5
A hospital aims to improve equity in cardiac care.
Which of the following best represents an equity-focused quality measure?