Directions: There are a total of 21 questions on this exam. Each question has one correct answer choice unless otherwise noted. Please mark your answer choice by circling the letter corresponding to your answer choice. In a 2007 study published in Health Affairs1, researchers report the results of a study examining the association between mortality and hospital quality performance measures in a sample of Medicare patients admitted for certain conditions. As per the authors:
“The Hospital Quality Alliance (HQA) program gives us the opportunity to systematically monitor the quality of hospital care nationwide. To gauge the importance of the HQA indicators, we examined the relationship between hospitals’ performance on HQA quality indicators and mortality for Medicare enrollees admitted for acute myocardial infarction, congestive heart failure, and pneumonia.”

Exhibit 3 below shows the resulting adjusted odds ratios of mortality for three separate HQA measures. The three measures are for AMI (acute myocardial infarction), CHF (congestive heart failure), and pneumonia. Each of these three measures was categorized into quartiles: the 1st quartile category includes the lowest 25% of the values, and the 4th quartile contains the largest 25% of the values.

The reference for the above comparisons is the 4th quartile of the relevant performance measure reflected in the column title.

1

Jha A, et al .The Inverse Relationship Between Mortality Rates And Performance In The Hospital Quality Alliance Measures. Health Affairs. 26, no. 4 (2007): 1104–1110

1

1. Based on the results presented in Exhibit 3, complete the following sentence: “After adjusting for multiple patient characteristics, the analyses show that _____” a. Higher HQA (AMI, CHF, Pneumonia) performance scores are generally associated with greater risk of patient mortality. b. Higher HQA (AMI, CHF,