With a strong commitment to Public Health and Injury Prevention and many provisions to ensure adequate Access to Emergency Care, Connecticut has a robust emergency care system. However, a difficult Medical Liability Environment and gaps in Disaster Preparedness resources need to be addressed.
Connecticut remains one of the top 10 states for Public Health and Injury Prevention. The state has some of the lowest fatal injury rates in the nation, with favorable rankings in its rates of fire- or burn-related deaths, accidental firearm-related deaths, accidental poisoning deaths, and fatal occupational injuries. Its rate of homicide and suicide is the fourth lowest (12.8 per 100,000 people). Connecticut's adult population is in relatively good health as well, with some of the lowest rates of adult smoking (17.1%) and obesity (24.5%).
Connecticut has solid rankings for its Quality and Patient Safety Environment, with high percentages of hospitals using computerized practitioner order entry (93.9%) and electronic medical records (97.0%). The state also has implemented a prescription drug-monitoring program that monitors drug schedules II through V and has a funded state emergency medical services medical director.
Connecticut's Access to Emergency Care is robust, with favorable ratios of providers to population for many of the medical specialties included in this report. The state has particularly good Access to Emergency Care services, with one of the highest rates of Level I or II trauma centers (3.6 per 1 million people) and high per capita numbers of emergency physicians. It also has 3.5 physicians accepting Medicare per 100 beneficiaries, which is higher than the national average. Connecticut's citizens have a high overall level of health insurance coverage, with only 5.3% of children and 9.6% of adults lacking insurance. This is tempered, however, by the relatively high proportion of children who are underinsured (19.0%).
Connecticut's Medical Liability Environment continues to be a challenge. The state has the third highest average medical liability insurance premiums for both primary care physicians ($24,211) and specialists ($110,269). The average premium for primary care physicians is more than $10,000 higher than the national average, while specialists in the state pay nearly twice the national average. Connecticut has few protections from lawsuits in place for practitioners, a relatively high number of malpractice award payments (2.4 per 100,000 people), and the seventh highest average malpractice award payment ($482,371).
Connecticut's lackluster grade in Disaster Preparedness is largely due to its failure to keep pace with other states' improvements. The state fell below the national average in its bed surge capacity (509.7 per 1 million people), burn unit beds (2.8 per 1 million), and intensive care unit beds (249.6 per 1 million). While Connecticut has the highest rate of physicians registered in its Emergency System for Advance Registration of Volunteer Health Professionals (656.8 per 1 million people), it lags behind other states in nurses and behavioral health professionals registered. It also lacks some of the policies and procedures that could enhance its ability to respond quickly to a largescale disaster, including the lack of integration into its medical response plan of the needs of patients dependent on medication for chronic conditions, psychotropic medication, or dialysis, as well as the lack of a statewide patient-tracking system.
Connecticut must work to improve its Medical Liability Environment and be steadfast in supporting liability protections that have been put in place, such as case certification requirements. A medical liability cap on noneconomic damages is also highly recommended, and mandatory pretrial screening panels could help discourage frivolous lawsuits. Additional liability protections are needed to help retain providers, discourage unnecessary lawsuits, and tamp down soaring medical liability insurance premiums and the correspondingly high average malpractice award payments.
Despite its strong health care workforce, Connecticut must improve access to quality emergency care by reducing factors that contribute to emergency department (ED) boarding and crowding. The state has one of the highest hospital occupancy rates in the nation (76.6 per 100 staffed beds) and relatively low rates of staffed inpatient beds (259.8 per 100,000 people) and psychiatric care beds (21.3 per 100,000 people). It also has few EDs (8.1 per 1 million people) and the sixth longest ED wait time in the nation: 351 minutes from ED arrival to departure for admitted patients. These issues point to a need for the state to invest in more hospital infrastructure to ensure that it can keep up with demand for services. Improving the medical infrastructure also will enable Connecticut to better respond to disasters where a surge in demand for beds and care is anticipated.