Oklahoma improved from 50th to 37th in the nation overall, largely due to major improvements in Disaster Preparedness. Unfortunately, the state failed to improve upon its poor grade in Access to Emergency Care and fell further behind in Public Health and Injury Prevention.
Oklahoma's Disaster Preparedness grade benefitted substantially from having implemented a statewide medical communication system with one layer of redundancy and a statewide syndromic surveillance system, as well as having significantly increased bed surge capacity (from 444.8 to 686.3 per 1 million people) and intensive care unit beds (312.5 to 412.6 per 1 million). The state passed Uniform Emergency Volunteer Health Professional Act model legislation to provide additional liability protections to health care workers during an event. The Oklahoma Medical Reserve Corps played a crucial role in rescue, shelter and recovery in the devastating EF5 tornadoes in Oklahoma in spring 2013.
Oklahoma continues to support a favorable Medical Liability Environment, having established and maintained a medical liability cap on noneconomic damages, collateral source rule reform, and case certification by expert witnesses. As a result, Oklahoma has medical liability insurance premiums below the national average for both primary care physicians and specialists and average malpractice award payments that are 18% lower than the average across the states.
While Access to Emergency Care in Oklahoma overall is poor, there were some highlights. The state ranks among the top 10 for many aspects of its hospital capacity, including emergency departments (ED) (30.7 per 1 million people), psychiatric care beds (46.7 per 100,000 people), and low hospital occupancy rate (57.3 per 100 staffed beds). As a result, it has the eighth lowest ED wait time: 211 minutes from ED arrival to ED departure for admitted patients. Some hospitals in the state are building freestanding EDs that could continue to expand timely Access to Emergency Care.
With regard to Access to Emergency Care, Oklahoma continues to struggle with shortages of emergency physicians, specialists, primary care providers, mental health providers, and registered nurses. The state has made little-to-no progress in recruiting and retaining health care providers since the 2009 Report Card, despite reducing the proportion of children without health insurance by nearly half and increasing Medicaid fee levels for office visits.
Oklahoma's Quality and Patient Safety Environment is lacking a number of policies and procedures aimed at improving emergency response. Survey data indicate that the state lacks a uniform system for providing pre-arrival instructions that could offer an opportunity for lifesaving care while awaiting an emergency medical services (EMS) response, as well as destination policies for ST-elevation myocardial infarction (STEMI) and stroke patients, although emergency physicians report that new state EMS protocols are supporting improvements in these areas. In addition, while Oklahoma supports the only real-time prescription drug monitoring program in the country, the state's hospitals fall well below average in adoption of electronic medical records and computerized practitioner order entry.
Public Health and Injury Prevention efforts in Oklahoma continue to lag behind the nation overall. Oklahoma has failed to pass smoke-free bans for restaurants, bars, or worksites, despite having the fourth highest rate of adult smokers (26.1%). The state also has among the 10 highest rates of fire- and burn-related deaths, poisoning-related deaths, which includes drug overdoses, and traffic fatalities.
Oklahoma should match its outstanding hospital capacity with an adequate physician workforce to improve overall Access to Emergency Care. The state must work to recruit and retain specialists, emergency physicians, primary and mental health care providers, and registered nurses. The Oklahoma Physician Manpower Commission is taking steps to address some of these problems through enhanced incentive programs for physicians, physician assistants, and nurses. They are currently focusing on filling primary care openings, especially in the rural areas of the state. A new emergency medicine residency program has graduated three classes with 94% of residents staying to practice in Oklahoma, and another emergency medicine residency program will open next year.
Oklahoma patients would also benefit from an increase in access to trauma centers and accredited chest pain centers: Currently, only 73% of the population is within 60 minutes of a level I or II trauma center, and the state has only 0.3 accredited chest pain centers per 1 million people. Increased access is important in light of the above mentioned Public Health and Injury Prevention concerns. Passing legislation that bans handheld cellphone use and texting for all drivers and requiring helmets for all motorcycle riders may help reduce Oklahoma's above-average rates of traffic fatalities for vehicle occupants, bicyclists, and pedestrians.