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Scenario: The quality committee at a hospital reviewed its performance measure- ment data for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia on the Medicare Hospital Compare website (www.medicare.gov/hospitalcompare). The hospital’s performance scores for pneumonia and CHF were very similar to the scores attained by hospitals in the state and throughout the nation. The hospital’s performance on the AMI measures was not as favorable. The results suggest that the hospital approached perfor- mance improvements in a fragmented, disease-specific manner.

Instructions: Consider how organizational goals may have contributed to some im- provements in care provided to patients with CHF and pneumonia while improve- ments in care for patients with AMI lagged. The measures for each of these condi- tions can be found on the Medicare website (www.medicare.gov). On the following goals worksheet, you will find examples of goal statements the hospital could have established that would have led to the results described. Critique each goal state- ment and document your critique on a worksheet such as the one shown here. Remember, you are critiquing the goal statement, not the merit of the intervention represented by the goal statement.

Goal Statement	Pros	Cons
Improve performance in all the CMS disease-specific indicators.
Ensure all patients admitted to the ED with the diagnosis of AMI receive aspirin within ____ minutes of admission.
Improve performance on the following AMI indicators: • Timeliness of administration of aspirin • Prescribing aspirin at discharge • Smoking cessation counseling
Research the available clinical guidelines on care of the patients with AMI, and implement a guideline that • demonstrates a strong degree of evidence; • ensures meeting all regulatory and payer requirements; and • permits ease of documenting, retrieving, and

reporting the necessary performance indicators.
Reduce the number of patients with AMI who are discharged without smoking cessation counseling and a prescription for aspirin.