Tuesday, December 09, 2008

Report Card Recommendations

Yesterday at a press conference in Washington, D.C. the American College of Emergency Physicians released the 2009 Report Card on the State of Emergency Medicine.  The Report Card makes eight national recommendations from a blue-ribbon panel of experts with expertise in areas including hospital emergency care, public health, disaster preparedness, injury prevention and emergency medical services.  Each state Report Card contains recommendations specific to each state.  The national recommendations are:


  1. Create stronger emergency departments through national health care reform.
  2. Alleviate boarding in emergency departments and hospital crowding.
  3. Pass the Access to Emergency Medical Services Act.
  4. Enact federal and state medical liability reforms.
  5. Infuse a greater level of federal funding and support into disaster preparedness targeted for medical preparedness and response.
  6. Increase support for the nation’s health care safety net.
  7. Develop greater coordination of emergency services.
  8. Increase the use of systems, standards and information technologies to track and enhance the quality and patient safety environment.


The five Report Card categories (and weightings) are:


·       Access to Emergency Care (30 percent) — the District of Columbia ranked first, and California ranked last.  This category contains 26 measures that include the number of emergency physicians and percent of population without health insurance.  New measures since the 2006 Report Card include the number of nurses and on-call specialists (e.g., surgeons, orthopedists), percent of physicians accepting Medicare, hospital closures in 2006 and staffed inpatients beds.  Other new measures assess what percent of the population live within 60 minutes of a trauma center and whether additional primary care or mental health services are needed in the state.   


·       Quality and Patient Safety Environment (20 percent) — Washington State ranked first, and South Dakota ranked last.  This category contains 15 measures  New measures include whether the state funds quality improvement of the state’s EMS system, requires reporting for adverse events and hospital-based infections or funds a state EMS medical director. Also included is whether the state has (or is working on) emergency cardiac and stroke systems of care and the percent of hospitals using computerized practitioner order entry and electronic medical records. 


·       Medical Liability Environment (20 percent)  — Colorado ranked first, and the District of Columbia ranked last.  This category contains 21 measures that include whether the state has caps on non-economic damages, uses pre-trial screening panels or has abolished joint and several liability.  New measures include average malpractice payments and the average medical liability insurance premiums of primary care physicians and medical specialists.  This category also assesses the number of lawyers (not included in the grading).


·       Public Health and Injury Prevention (15 percent) – Massachusetts ranked first, and Louisiana ranked last.  This category contains 23 measures that include the percent of alcohol-related traffic fatalities and seat belt use, as well as motorcycle helmet use.  New measures include whether states have child safety seat legislation and the percent of the population that are obese, smoke and engage in binge drinking.  In addition, new measures include what percent of tobacco settlement funding is spent on health-related services and programs and the number of homicides and suicides. 


·       Disaster Preparedness (15 percent) — the District of Columbia ranked first, and Tennessee ranked last.  This new category has 31 measures that include how much federal disaster preparedness funds are spent per capita for medical preparedness and whether an all-hazards medical response plan is being used.  It also includes whether the state planning process involves input from emergency physicians and whether plans are in place for patients with special needs, such as those who need medications or dialysis.  In addition, it assesses whether the state has a real-time notification system (to notify health care providers of a disaster), a statewide patient tracking system, a statewide victim tracking system or a real-time (or near real-time) syndromic surveillance system. This category also assesses whether physicians and nurses are trained to respond to disasters, the state’s bed surge capacity and the number of ICU and burn unit beds.  It also assesses whether there are liability protections in place for health care workers during a disaster. 


The National Report Card on the State of Emergency Medicine was made possible, in part, by funding from the Emergency Medicine Foundation, which gratefully acknowledges the support of The WellPoint Foundation and the Robert Wood Johnson Foundation.

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