The sequence of events is best described as:

• A. NPDB opened first, then HCQIA passed
• B. HCQIA passed first, then NPDB opened
• C. NPDB opened and HCQIA passed in the same year
• D. HCQIA passed after NPDB opened

Answer: (B)

The sequence shown reflects the actual timeline: the Health Care Quality Improvement Act (HCQIA) was enacted first, in 1986, and it created the framework that led to the National Practitioner Data Bank (NPDB). The NPDB began operating a few years later, opening in 1990. Because the data bank was established by the act, it could not open before HCQIA existed. So the best description is that HCQIA passed first, then the NPDB opened. Options suggesting the NPDB opened before the act or in the same year don’t fit the historical sequence.