Captsone Case E

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Dec 6, 2023

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Tyrell Murphy Capstone Case E. 1. No. Tufts Medical Center, Brigham and Women’s hospital, Faulkner hospital, Boston medical center, Beth Israel Deaconess, and Mass. General Hospital do not lack any measures that are presumably indicative of the capacity to provide care. They all have the same structure measures. 2. These measures are called process measures because it’s what actually done to the patient, that is the sequence and coordination of activities. These measures include the technical aspects of care, or the science of care as well as the interpersonal aspects of care or the art of care (i.e. how patients are treated). 3. Brigham and Women’s Hospital has a longer median waiting time in the Emergency Department before being admitted to the hospital as an inpatient (300 minutes), longer than both the state and national averages. Brigham and Women’s Hospital has a lower than state average time spent in the Emergency Department after being admitted as an inpatient after being admitted as an inpatient (88 minutes). However, it’s higher than the national average. Patients assessed and given influenza vaccination is much higher in Brigham and Women’s Hospital (99%) than the state average (88%) and also higher than national average (93%). Healthcare workers at Brigham and Women’s had an higher than average vaccination rate compared to state (82%) and national (90%) averages. Average median time all patient spend in Brigham and Women’s ED before leaving from visit is 210 minutes, which is much longer than state (131 minutes) and national (135 minutes). Average median time in mental health patients spent in Emergency Department before leaving from visit is 290 minutes which is a lot longer than the state average of 156 minutes and the national average of 208 minutes. Patients leaving the ED before being seen is lower at Brigham and Women’s at 1% compared to state and national averages of 2%. Appropriate follow up interval for normal colonoscopy in average-risk patients is 97% at Brigham and Women’s which is higher than the state (87%) and national average (88%).

Colonoscopy interval for patients with a history of adenomatous polyps – avoidance of inappropriate use (%) is 96% at Brigham and Women’s. This is much higher than the state average of 82% and higher than the national average of 90%. Brigham and Women’s have non- applicable data for both external beam radiotherapy for bone melases and for mothers whose deliveries were delivered too early. Therefore, there’s no data to compare next to state and national averages. Brigham and Women’s have 55% at appropriate care for severe sepsis and septic shock which is around the state average of 54%. Appropriate care was lower at Brigham and Women’s when compared to the national average of 57%. 4.-5. Exhibit E3-Hospital Acquired Infections, 2018. To calculate the SIR, I would divide the actual cases by the expected cases. Central Line Associated Bloodstream Infections Hospital Expected Cases Actual Cases SIR Lower CI Upper CI Compar ed to US Tufts 19.744 9 .456 .222 .837 Better Brigham & Women’s 45.293 35 .773 .547 1.063 Average Faulkner Hospital 3.067 3 . 978 .249 2.662 Average Boston Medical Center 19.255 15 .779 .453 1.256 Average Beth Israel Deaconess 3.822 0 0 - .784 Better Massachusetts General 64.279 63 . 980 .760 1.246 Better Catheter Associated Urinary Tract Infection Expected cases Actual cases SIR Lower CI Upper CI Compar ed to US Tufts 19.959 38 1.90 1.367 2.586 worse Brigham & Women’s 53.336 66 1.19 0.965 1.564 average Faulkner 2.765 4 1.45 .460 3.49 average Boston 18.103 21 1.16 .737 1.743 average Beth Israel 4.302 1 .232 .012 1.146 average

Mass. General 85.676 59 .689 .529 .882 better MRSA Expected cases Actual cases SIR Lower CI Upper CI Compar e to the US . Tufts 10.694 7 .655 .286 1.295 average B&W 24.353 17 .698 .420 1.095 average Faulkner 1.204 0 0 - 2.488 worse Boston Medical Center 12.506 11 .880 .463 1.529 average Beth Israel Mass General. 1.648 26.784 1 22 .607 .821 .030 .528 2.993 1.223 Average Average Clostridium difficile Expected cases Actual cases SIR Lower CI Upper CI Compared to US Tufts 60.486 52 .860 .649 1.119 average B&W 178.678 118 .660 .549 .788 average Faulkner 14.208 18 1.23 .774 1.963 average Boston 95.531 79 .827 .659 1.025 average Beth Israel 34.777 38 1.09 .784 1.484 average Mass Gen. 253.977 226 .890 .779 1.012 average SSI: Colon Surgery Expected cases Actual cases SIR Lower CI Upper CI Compared to US Tufts 4.927 4 .812 0.258 1.958 average B&W 25.126 24 .995 0.652 1.458 average Faulkner 1.088 1 .919 .046 4.533 average Boston 5.573 5 .897 .329 1.989 average Beth Israel 2.597 1 .385 .019 1.899 average Mass. Gen. 18.632 13 .698 .163 1.163 average SSI: Abdominal Hysterectomy

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Expected cases Actual cases SIR Lower CI Upper CI Compared to US Tufts 1.247 2 1.60 .269 5.299 Average B&W 4..436 1 .225 .011 1.112 Average Faulkner .175 0 0 N/A N/A N/A Boston 1.264 1 .791 .04 3.902 Average Beth Israel .189 1 5.29 N/A N/A Average Mass. General 2.666 3 1.13 .286 3.063 Average 6. 30 Day Mortality Rates-2016-2018, US mortality rates are 12.9 for AMI, 11.5 for CHF, 8.5 for COPD, and 13.8 for stroke. AMI denominator score Low estimate High estimate Compared to US. tufts 176 13.3 10.5 16.7 average B&W 364 10.3 8.4 12.6 better Faulkner 48 11.4 8.9 14.8 average Boston 132 12.8 9.9 16.3 average Beth Israel 340 11.9 9.7 14.4 average Mass. Gen. 715 10.2 8.6 12.0 better CHF Denominator score Low estimate High estimate Compared to US tufts 327 10.2 7.9 13.1 Average B&W 1,053 8.1 6.8 9.6 Better Faulkner 410 8.9 7.0 11.3 Better Boston 549 7.1 5.5 9.0 Better Beth Israel 566 9.6 7.8 11.8 Same Mass. Gen. 1,670 7.7 6.6 8.9 Better COPD

Denominato r Score Low estimate High estimate Compared to US Tufts 129 8.8 6.2 12.1 average B&W 237 6.2 4.7 8.2 Better Faulkner 207 8.0 5.9 10.8 Average Boston 186 7.5 5.5 10.2 Average Beth Israel 572 7.0 5.5 8.8 Average Mass. Gen 552 6.7 5.5 8.5 average Stroke Denominator Score Low Estimate High Estimate Compared to US Tufts 172 14.6 11.6 18.2 Average B&W 513 15.2 13.1 17.6 Average Faulkner 99 12.4 9.4 16.2 Average Boston 239 15.7 12.7 19.1 Average Beth Israel 248 11.6 9.1 14.5 Average Mass. General 797 15.0 13.1 17.2 Average 7. 30 Day readmission rates 2015-2018, US 30-day readmission rates are 15.7 for AMI, 21.6 for CHF, 19.5 for COPD, and 16.6 for pneumonia. AMI denominator score Low estimate High estimate Compared to US Tufts 298 18.3 15.4 21.3 same B&W 596 16.2 14.1 18.4 same Faulkner 29 15.7 12.5 19.5 same Boston 161 16.1 13.3 19.5 same Beth Israel 185 16.2 13.5 19.4 same Mass Gen. 927 17.1 15.1 19.0 same Congestive Heart Failure denominator Score Low estimate High Estimate Compared to

US Tufts 486 24.2 21.5 27.1 Same B&W 1,380 23.9 21.9 25.9 Worse Faulkner 480 22.5 19.8 25.6 Worse Boston 719 21.6 19.2 24.2 Same Beth Israel 646 21.0 18.5 23.6 Same Mass Gen. 2,025 20.7 19.3 22.3 Same COPD Denominator Score Low estimate High estimate Compared to US Tufts 176 18.3 15.7 21.4 Same B&W 284 19.5 16.8 22.3 Same Faulkner 264 20.8 17.9 24.0 Same Boston 231 20.0 17.4 23.2 Same Beth Israel 679 20.4 18.1 23.0 Same Mass Gen. 670 17.4 15.4 19.7 Same Pneumonia Denominator Score Low Estimate High Estimate Compared to US Tufts 310 17.0 14.4 20.0 Same B&W 805 19.4 17.4 21.7 Worse Faulkner 426 16.2 13.8 19.1 Same Boston 301 18.6 16.0 21.7 Same Beth Israel 896 18.0 16.0 20.4 Same Mass Gen. 1,563 17.0 15.5 18.6 Same 8. If the upper confidence limit is greater than the US PSI rate, then the hospital is worse than the US PSI rate, then the hospital is better than the US average. If the lower confidence limit is greater than the US PSI rate, then the hospital is worse than the US average. If the upper and lower confidence intervals include the US PSI rate, then the hospital’s PSI rate is neither better nor worse than the national norm.

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US patient safety indicator rates are 3.85 for serious blood cots after surgery, 0.95 for wound split after surgery on abdomen or pelvis, 0.52 for pressure sores,163.01 for deaths among patients with serious complications after surgery, 1.29 for accidental cuts and tears from medical treatment, and 0.27 for collapsed lung due to medical treatment. NA: not available. Serious Blood clots after surgery denominator score Low estimate High estimate Compared to US Tufts 3,457 3.78 2.16 5.39 Same B&W 11,587 5.09 4.13 6.05 Worse Faulkner 1,946 2.40 .18 4.61 Same Boston 2,815 6.15 4.36 7.94 Worse Beth Israel 2,195 2.79 .78 4.80 Same Mass Gen. 13,385 4.47 3.54 5.40 Same Wound Split After Surgery on Abdomen or Pelvis denominator score Low estimate High estimate Compare to US Tufts 635 1.04 .08 2.00 Same B&W 3,093 .74 .01 1.47 Same Faulkner 387 .89 0 1.91 Same Boston 718 1.03 .07 1.99 Same Beth Israel 433 .87 0 1.88 Same Mass Gen. 3,422 .98 .27 1.69 Same Pressure Sores denominator score Low estimate High estimate Compared to US Tufts 6,648 .88 .50 1.27 Same B&W 22,931 .71 .48 .95 Same Faulkner 5,065 .12 0 .73 Same Boston 7,075 .24 0 .66 Same

Beth Israel 7,145 .20 0 .70 Same Mass Gen. 30,093 .32 .09 .54 Same Deaths among Patients with serious complications after surgery denominator score Low estimate High estimate Compared to US Tufts 248 151.32 122.46 180.19 same B&W 519 186.09 161.15 211.02 same Faulkner NA NA NA NA NA Boston 162 181.45 147.74 215.16 Same Beth Israel 50 148.14 97.57 198.71 Same Mass Gen. 721 158.26 136.86 179.66 Same Accidental Cuts and Tears from Medical Treatment denominator Score Low estimate High estimate Compared to US Tufts 1,663 1.40 .39 2.41 Same B&W 6,553 .46 0 1.09 Better Faulkner 1,065 1.27 .12 2.42 Same Boston 1,928 1.37 .37 2.38 Same Beth Israel 1,384 1.17 .06 2.27 Same Mass Gen. 8,330 1.36 .74 1.97 SAME Collapsed Lung due to Medical Treatment Denominator Score Low Estimate High Estimate Compared to US Tufts 8,240 .35 .16 .54 Same B&W 23,990 .19 .04 .33 Same Faulkner 7,251 .26 .05 .48 Same Boston 9,615 .32 .13 .51 Same Beth Israel 10,467 .22 .03 .42 Same Mass Gen. 31,477 .36 .23 .5 Same 9.

Tufts Medical Center Brigham & Women’s Hospital Faulkner Hospital Boston Medical Center Beth Israel Deaconess Mass. General CLABSI Better Better Better Better Better Better CAUTI Worse Average Average Average Average Better MRSA Average Average Worse Average Average Average C. diff Average Average Average Average Average Average SSI: Colon Average Average Average Average Average Average SSI: Hysterectomy Average Average N/A Average N/A Average Mortality AMI Average Better Average Average Average Better Mortality CHF Average Better Better Better Average Average Mortality COPD Average Better Average Average Average Average Mortality stroke Average Average Average Average Average Average Readmissions: AMI Average Average Average Average Average Average Readmissions: CHF Average Worse Worse Average Average Average Readmissions: COPD Average Average Average Average Average Average

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Readmissions: pneumonia Average Worse Average Average Average Average Blood clots Average Worse Average Worse Average Average Wound split average average average average average average Pressure sores average average average average average average Complication deaths average average N/A average average average Cuts and tears average better average average average average Collapsed Lung Average average average average average average

Captsone Case E

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