NCQA: ADVANCING THE QUALITY AGENDA IN MANAGED HEALTH CARE

Robert Swenson, a 64-year-old white male, is admitted to the internal medicine ward of a community hospital with substernal chest pain, shortness of breath, and new Q waves in leads II, III, and aVF on electrocardiogram. Reviewing the patient’s chart during the course of his admission, the senior resident, Pamela Hurst, notes several risk factors for an acute myocardial infarction (MI): a history of intermittently elevated systolic blood pressure (perhaps treated in the remote past; the chart is unclear), a history of hypercholesterolemia (with a fasting low-density lipoprotein [LDL] cholesterol level of 142 mg/dL on the patient’s current dose of statin therapy), a prior MI (approximately 8 months before the current admission), and a pack-a-day smoking habit (with a 30 pack-year history). Furthermore, Dr. Hurst sees no evidence that Mr. Swenson has been taking a β-blocker since his previous MI. “Why,” Dr. Hurst says to herself with some exasperation, “didn’t anyone DO anything to prevent this man’s second heart attack? Isn’t anybody watching this patient? Doesn’t anybody care?”