AMERICA’S EMERGENCY
CARE ENVIRONMENT

Oregon

Category Grades
2009
RankGrade
2014
RankGrade
Overall:
47D 32D+
Access to Emergency Care:
41F 35F
Quality/Patient Safety:
36D+ 21C+
Medical Liability:
37D- 35D
Public Health/ Injury Prevention:
9B 3A-
Disaster Preparedness:
42D 37D-


Oregon improved slightly in almost every category moving from 47th to 32nd place overall, but the state continues to receive low grades in Access to Emergency Care and Disaster Preparedness.

More Information

Strengths

Oregon's Quality and Patient Safety Environment has seen significant improvement since the 2009 Report Card, largely due to improvements in hospital systems. The state ranks among the best 10 in the nation with regard to hospital adoption of electronic medical records (96.7%), the proportion of hospitals collecting data on patients' race and ethnicity and primary language (83.1%), and percentage of hospitals planning to develop a diversity strategy (58.5%). The state has also implemented changes since 2009 that contributed to the overall category grade, including requiring adverse event reporting and development of stroke and ST-elevation myocardial infarction (STEMI) systems of care.

Oregon continues to rank among the best with regard to Public Health and Injury Prevention, benefiting from low rates of traffic fatalities that are supported by strong traffic safety legislation. The state supports a motorcycle helmet law; distracted driving laws that ban handheld cellphone use and texting for all drivers; and primary enforcement of adult seatbelt laws, which likely contribute to the third highest seatbelt use rate (96.6%) and 10th lowest traffic fatality rate (6.5 per 100,000 people) in the nation. Oregon also benefits from having the lowest rate of childhood obesity (9.9%) and moderately low rates of smoking and binge drinking among adults.

Challenges

Access to Emergency Care remains a major challenge for people of Oregon, especially with regard to access to care for children. Despite the state having a below-average rate of uninsured children (7.4%), more than one in five children who have insurance is underinsured, with unreasonable costs being reported by their parents. Only 93.7% of children can see a provider when needed, placing Oregon third worst in the nation for this measure. It is also last in the nation for the number of staffed inpatient beds (204.9 per 100,000 people) and has the fourth fewest psychiatric care beds (8.7 per 100,000 people), representing a significant decline from the 28.8 psychiatric care beds per 100,000 reported in 2009.

Oregon continues to lack many Disaster Preparedness practices and policies that other states have implemented. For instance, the state has not incorporated patients dependent on medication for chronic conditions, patients dependent on dialysis, or patients on psychotropic medication in its medical response plan. Oregon also lacks a statewide patient-tracking system and has the sixth lowest bed surge capacity in the nation (304.2 per 1 million people). Its capacity for handling a disaster event is below the national average with regard to burn unit beds (4.1 per 1 million people) and intensive care unit beds (257.5 per 1 million people).

Oregon continues to support an unfavorable Medical Liability Environment. The state enacted legislation in 2013 that facilitates voluntary discussions between providers and injured patients and allows for early offers of compensation for adverse medical events. However, few other reforms are in place and the state's average malpractice award payment skyrocketed from $251,695 in the previous Report Card to $371,605, representing a 48% increase, despite little change in the number of malpractice award payments (1.3 per 100,000 people).

Recommendations

Oregon must take immediate action to address Access to Emergency Care for all, but especially for its most vulnerable populations. The state should work to increase access to primary care and specialist care for children, the availability of trauma centers and accredited chest pain centers, and access to substance abuse treatment. While the state has a fair supply of emergency physicians, extremely low rates of staffed inpatient beds and psychiatric care beds contribute to crowding and boarding practices in the emergency department.

While Oregon fared well with regard to Public Health and Injury Prevention, the state must work to stop a troubling trend: Childhood immunizations have plummeted since the last Report Card (from 78.8% to 67.0%), as have influenza vaccination rates among the elderly (from 71.3% to 54.2%). Immunizations are a cost-effective, life-saving measure; failure to increase immunization rates could have a major negative impact on the overall emergency care system, draining already limited resources.

Oregon must create a more favorable Medical Liability Environment by implementing pretrial screening panels and expert witness rules that provide for case certification and require that experts are of the same specialty as the defendant. Oregon should also consider providing appropriate liability protections for care mandated by the Emergency Medical Treatment and Labor Act. A failure to do so could further discourage specialists from providing critical on-call services to emergency patients.

Access to Emergency Care

Title 2009
Report Card
2014
Report Card
Board-certified emergency physicians per 100,000 pop 13.4 14.3
Emergency physicians per 100,000 pop 15.6 17.5
Neurosurgeons per 100,000 pop 2.5 2.7
Orthopedists and hand surgeon specialists per 100,000 pop 9.4 10
Plastic surgeons per 100,000 pop 1.8 2.2
ENT specialists per 100,000 pop 3.9 3.7
Registered nurses per 100,000 pop 804.6 800.4
Percent of children able to see provider 93.7
Level I or II trauma centers per 1M pop 1.3 1.3
Percent of population within 60 minutes of Level I or II trauma center 76.4 79
Accredited chest pain centers per 1M pop 0.3 0.1
Percent of population with an unmet need for substance abuse treatment 8.5 8.9
Pediatric specialty centers per 1M pop 2.7 2.1
Medicaid fee levels for office visits as a percent of the national average 96.3 103.9
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) 0 32.6
Percent of adults with no health insurance 19.3 15.7
Percent of adults underinsured 7.9
Percent of children with no health insurance 13.1 7.4
Percent of children underinsured 20.1
Percent of adults with Medicaid 7.1 9.6
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 210.8 204.9
Hospital occupancy rate per 100 staffed beds 65.9 62.3
Psychiatric care beds per 100,000 pop 28.8 8.7
Median time from ED arrival to ED departure for admitted ED patients 234
State collects data on diversion NR NR

Disaster Preparedness

Title 2009
Report Card
2014
Report Card
Per capita federal disaster preparedness funds $8.70 $5.82
State budget line item health care surge NO
ESF-8 plan is shared with all EMS and essential hospital personnel YES YES
Emergency physician input into the state planning process YES, YES YES
Public health and emergency physician input during an ESF-8 response YES, NO
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP) NO NO
Special needs patients included in medical response plan NR YES
Patients dependent on medication for chronic conditions in medical response plan NR NO
Medical response plan for supplying dialysis NR NO
Mental health patients included in medical response plan YES
Medical response plan for supplying psychotropic medications NO
Mutual aid agreements in place with behavioral health providers STATE LEVEL
State requires long-term care and nursing home facilities to have a written disaster plan YES
State able to report number of exercises involving long-term care facilities or nursing NO
Just-in-time training systems in place STATEWIDE COUNTY OR CITYWIDE
Statewide medical communication system with one layer of redundancy YES YES
Statewide patient tracking system NO NO
Statewide real-time or near real-time syndromic surveillance system YES YES
Real-time surveillance system in place for common ED presentations YES YES, STATEWIDE
Bed surge capacity per 1M pop 309.5 304.2
ICU beds per 1M pop 251.1 257.5
Burn unit beds per 1M pop 4.3 4.1
Verified burn centers per 1M pop 0.266847767 0.3
Physicians registered in ESAR-VHP per 1M pop 0 15.9
Nurses registered in ESAR-VHP per 1M pop 0 234.1
Behavioral health professionals registered in ESAR-VHP per 1M pop 7.4
Strike teams or medical assistance teams YES YES
Disaster training required for essential hospital/EMS personnel NO, NO NO
Percent of RNs that received emergency training 48 43.4

Medical Liability Environment

Title 2009
Report Card
2014
Report Card
Lawyers per 10,000 pop 13.4 13.3
Lawyers per physician 0.5 0.5
Lawyers per emergency physician 8.4 7.6
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 1.5 1.3
Average malpractice award payments $251,696 $371,605
National Practitioner Databank reports per 1,000 physicians 16.3 22.5
Apology laws: Apology is inadmissible as evidence in a court of law YES
State has implemented a patient compensation fund NO NO
Number of insurers writing medical liability policies per 1,000 physicians 6.3 6.7
Average medical liability insurance premiums for primary care physicians $9,686 $8,230
Average medical liability insurance premiums for specialists $48,511 $39,030
Presence of pretrial screening panels NONE NO
Pretrial screening panel's findings admissible as evidence N/A N/A
Periodic payments are: required, granted upon request, at court's discretion NO NO
Medical liability cap on non-economic damages NONE NONE
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished YES PARTIALLY
Collateral Source Rule/Provides for Awards to be Offset YES
State provides for case certification NO NO
Expert witness required to be of the same specialty as the defendant NO NO
Expert witness must be licensed to practice medicine in the state NO NO

Public Health & Injury Prevention

Title 2009
Report Card
2014
Report Card
Bicyclist fatalities per 100,000 cyclists 1.4
Pedestrian fatalities per 100,000 pedestrians 3.0
Percent of traffic fatalities alcohol-related 41 35
Percent of front occupants using restraints 95.3 96.6
Child safety seat/seat belt legislation - score out of a possible 10 points 7 8
Helmet use required for all motorcylce riders YES YES
Distracted driving legislation score - out of a possible 4 points 4
Graduated drivers' licenses legislation score -out of a possible 5 points 1
Percentage of children aged 19-35 months who are immunized 78.8 67.0
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 71.3 54.2
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 74.7 76
Fatal occupational injuries per 1M workers 39.5 26.1
Homicides and suicides (non-motor vehicle)(per 100,000) 18.2 19.5
Unintentional fall-related fatal injuries (per 100,000) 10.4 13.9
Fire/burn related fatal injuries (per 100,000) 0.9 0.7
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.3 0.1
Rate of unintentional poisoning-related deaths (per 100,000) 10.1
Total injury prevention funds per 1,000 persons $182.79 $283.94
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding YES
Dedicated occupational injury prevention funding NO
Anti-smoking legislation score - score out of a possible 3 points 3
Infant mortality rate per 1,000 live births 5.9 4.9
Percentage of adults who binge drink 14.1 16.5
Percentage of adults who currently smoke 18.5 19.7
Percentage of adult population who are obese (BMI > 30.0) 24.8 26.7
Percentage of children who are obese 9.9
Cardiovascular disease disparity ratio 1.6
HIV diagnosis disparity ratio 5.8
Infant mortality disparity ratio 2.1

Quality & Patient Safety

Title 2009
Report Card
2014
Report Card
Funding for quality improvement within the EMS system NO NR
Funded state EMS medical director YES YES
Emergency medicine residents per 1M pop 7.2 8.2
Adverse event reporting required NO YES
% of counties with Enhanced 911 capability 100 100
State has a uniform system for providing pre-arrival instructions NO NR
State uses CDC guidelines for state field triage protocols YES (2011)
State has or is working on a stroke system of care NO YES
State has triage and destination policy in place for stroke patients NR
State has or is working on a PCI network or a STEMI system of care NO YES
State has triage and destination policy in place for STEMI patients NR
State maintains statewide trauma registry YES YES
State has triage and destination policy in place for trauma patients NR
Prescription drug monitoring program score (range 0-4) 2
% of hospitals with computerized practitioner order entry 24.1 83.6
% of hospitals with electronic medical records 56.9 96.7
% of patients with AMI given PCI within 90 minutes of arrival 59 91
Median time to transfer to another facility for acute coronary intervention 51
% of patients with AMI who received aspirin within 24 hours 99
% of hospitals collecting data on race/ethnicity and primary language 83.1
% of hospitals with or planning to develop a diversity strategy or plan 58.5

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