Louisiana continues to support one of the best Disaster Preparedness systems in the nation, with robust training and well-developed plans and policies in place. However, the state has faltered in its Quality and Patient Safety Environment, which lacks similar statewide policies and procedures for providing superior care.
Louisiana's Disaster Preparedness is third best in the nation. The state has strong protocols and plans to help ensure the safety of medically fragile patients and a demonstrated commitment to including stakeholders' input in the state's planning. Louisiana has robust systems for preparing emergency workers, with just-in-time training systems available statewide and a well-above-average rate of nurses who have received disaster training (42.2%). The state's medical workforce is engaged, with the fifth highest per capita rate of physicians registered in the Emergency System for Advance Registration of Volunteer Health Professionals (146.7 per 1 million people). Louisiana also has secured additional liability protections for health care workers during a disaster by passing Uniform Emergency Volunteer Health Practitioners Act model legislation.
Louisiana's Medical Liability Environment is moderate and boasts the lowest average malpractice award payments in the nation at $75,882óa 75% decrease since the previous Report Cardóalthough the number of award payments has increased significantly (3.6 per 1,000 physicians), as has the number of National Practitioner Databank Reports (55.6 per 1,000 physicians), which indicates the high number of cases that are reviewed. Louisiana has enacted several reforms that protect its health care workforce, including mandatory pretrial screening panels whose findings are admissible as evidence, required periodic payments of awards, and a medical liability cap on damages.
Adequate Access to Emergency Care continues to be a major concern in Louisiana, which has among the highest rates of adults and children without health insurance (23.9 and 11.6%, respectively) and a desperate need for primary care and mental health care providers. Access to trauma centers is particularly problematic as well, with the fewest Level I or II trauma centers per capita (0.4 per 1 million people) and a low proportion of its population living within 60 minutes of a Level I or II trauma center (59.1%).
While Louisiana's provisions for Quality and Patient Safety are among the weakest in the nation, initiatives are underway to address some of the key areas of concern. For example, while the state does not fund quality improvement efforts within the emergency medical services (EMS) system, the Bureau of Health Standards requires mandatory reporting of quality assurance for ambulance licensure and renewals. Additionally, while the state does not currently have ST-elevation myocardial infarction (STEMI) or stroke systems of care, the Louisiana Emergency Response Network has been working with its provider partners throughout the state to make substantial progress towards developing those systems.
Louisiana continues to face many challenges in the area of Public Health and Injury Prevention. Traffic safety is a pressing concern: Louisiana has the second highest rate of pedestrian deaths in the nation (12.0 per 100,000 pedestrians) as well as high rates of motor vehicle occupant deaths (13.7 per 100,000 people). Louisiana's people also face dire health risk factors, with high proportions of adults who smoke (25.7%) and high rates of obesity among adults and children (33.4 and 21.1%, respectively). The state has among the 10 highest infant mortality rates (7.6 deaths per 1,000 live births) and infant mortality disparity ratios (3.3), which means that the mortality rate among non-Hispanic Black infants is more than three times higher than the racial and ethnic group with the lowest rate.
Louisiana should work to improve its Quality and Patient Safety Environment by investing in improvements to the EMS system and funding a state EMS medical director. The state should continue efforts to fully implement systems of care for stroke and STEMI patients.
Louisiana must make a concentrated effort to address the poor health risk factors affecting the health and well-being of all through outreach and education aimed at reducing smoking and obesity, as well as measures to improve access to primary and preventive care. A public health commitment to improving traffic safety for motorists, bicyclists, and pedestrians alike is also needed.
The state's poor showing in Access to Emergency Care could be improved by a focus on ensuring that Louisiana's denizens have access to adequate health insurance. At the same time, the state must invest in provider recruitment and retention to fill the gaps in access to primary care.