Although Oregon ranked among the top 10 states in Public Health and Injury Prevention, that was more than offset by subpar grades in the remaining categories, including a failing grade for Access to Emergency Care and a ranking among the bottom 10 in Disaster Preparedness.
Strengths. Oregon’s performance is strongest in Public Health and Injury Prevention. The state ranks first for the percentage of adults aged 65 and older who have ever had a pneumococcal vaccine (74.7 percent), and the rate of annual influenza vaccine among that population is only slightly lower (71.3 percent). The state also has below-average rates of smokers and binge drinkers (18.5 and 14.1 percent of adults, respectively). Seat belt use is third highest in the nation, with 95.3 percent of front occupants using seat belts. Oregon also has shown considerable commitment to improving the health and safety of the population through relatively high levels of funding for intentional injury prevention programs ($221.48 per 1,000 people).
Despite Oregon’s poor grade with regard to Disaster Preparedness, the state has made some strides in this area. The state has numerous communications systems in place, including statewide “just-in-time” training systems, a statewide medical communication system with one layer of redundancy, and a real-time notification system to notify identified health care providers of an event.
Challenges. Access to all types of medical care in Oregon poses serious concerns. For instance, the state has higher-than-average rates of uninsured adults and children. More than 13 percent of children and 19 percent of adults in Oregon are uninsured, compared to national rates of 11.7 and 17.2 percent, respectively. The state also has the third lowest rate of staffed inpatient beds (210.8 per 100,000 people).
The Medical Liability Environment in Oregon is in need of reform. The state lacks many reforms aimed at retaining physicians and lowering medical liability premiums that other states have implemented. Oregon lacks expert witness rules such as requiring case certification by an expert witness and requiring witnesses to be of the same specialty as the defendant. The state also lacks a medical liability cap on non-economic damages and liability protections for EMTALA-mandated emergency care.
Oregon’s poor grade for the Quality and Patient Safety Environment is partially due to the lack of funding for an EMS quality improvement program, as well as a lack of formal stroke and PCI/STEMI systems of care. Additionally, the state does not have a hospital-based infections reporting requirement and has a relatively low rate of emergency medicine residents (7.2 per 1 million people), a result of having only one residency program in the state.
Recommendations. Along with many problems identified in the Access to Emergency Care category, Oregon’s emergency physicians also report significant problems with boarding of patients in the emergency department. Efforts should be made to address this problem, such as improving the excessively low rates of staffed inpatient and ICU beds. Further, despite the moderate number of psychiatric care beds compared with other states (28.8 per 100,000 people), emergency physicians report significant problems with patients being unable to access mental health care services; this problem must also be addressed. A first step in improving access to care for all residents would be to address the state’s relatively high rates of uninsured adults and children.
Oregon has the opportunity to substantially improve the Medical Liability Environment in the state. Policymakers should vigorously support a constitutional amendment permitting medical liability caps on non-economic damages. In addition, Oregon could benefit from stronger expert witness rules and implementation of pretrial screening panels. With emergency physicians in the state reporting problems in accessing specialists willing to provide on-call emergency services, particularly in rural areas, the state should consider enacting special liability protections for EMTALA-mandated care.
Finally, funding for an EMS quality improvement program and investing in the development of formal stroke and PCI/STEMI systems of care would substantially improve Oregon’s Quality and Patient Safety Environment.