Utah ranked among the top five states in the nation for both the Public Health and Injury Prevention and the Quality and Patient Safety Environment categories. However, high rates of uninsured residents and low facility capacity helped lead to poor marks in Access to Emergency Care.
Strengths. Utah has invested in the Quality and Patient Safety Environment through funding of quality improvement within the EMS system, as well as a state EMS medical director position. The state also has or is working on a stroke system of care and a PCI network or STEMI system of care and maintains a statewide trauma registry. Utah hospitals also demonstrate high usage of computerized practitioner order entry and electronic medical records (39.0 and 64.3 percent, respectively).
Utah fares quite well regarding Public Health and Injury Prevention indicators, with the nation’s lowest infant mortality rate (4.5 deaths per 1,000 live births), as well as a relatively low percentage of obese adults (21.9 percent). Less than 10 percent of Utah’s adult population are current smokers or binge drinkers, for which the state ranked first and third in the nation, respectively. On a related indicator, the state has the lowest percentage of traffic fatalities that are alcohol-related (24.0 percent).
Utah also has a relatively low percentage of persons needing, but not receiving, treatment for substance abuse services (7.6 percent). Other highlights with regard to Access to Emergency Care include relatively high rates of physicians accepting Medicare (3.5 per 100 beneficiaries) and pediatric specialty centers (5.0 per 1 million people).
Challenges. Access to Emergency Care in Utah is cause for concern. The state’s grade on this indicator was strongly affected by high rates of uninsured children and adults, as well as a relatively low percentage of adults insured through Medicaid. In addition, the state lacks any accredited chest pain centers and has the second lowest rate of staffed inpatient beds in the nation (210.2 per 100,000 people). Utah also has the fifth lowest rate of registered nurses currently in the workforce (646.2 per 100,000).
While Utah’s average malpractice award payment is the 10th lowest in the nation, the average medical liability insurance premiums for specialists ($68,352) are still higher than the average across the states. In addition, the state has not implemented expert witness rules such as case certification, requiring the witness to be of the same specialty as the defendant, or requiring witnesses to be licensed to practice medicine in the state. The state’s $400,000 medical liability cap on non-economic damages (indexed for inflation) is above the recommended hard $250,000 cap.
While Utah has demonstrated initiative in planning for Disaster Preparedness, the state still lacks written plans for special needs patients, statewide patient and victim tracking systems, and a real-time or near real-time syndromic surveillance system. The state also lacks a real-time surveillance system for common emergency department presentations. Utah has a relatively low level of federal funding for disaster preparedness ($8.05 per capita) and falls below average with regard to bed surge capacity and burn unit beds (366.7 and 4.5 per 1 million people, respectively).
Recommendations. Utah could improve access to medical care by increasing the percentage of the population with health insurance coverage, thereby encouraging preventive care and decreasing the likelihood that patients will present to the emergency department with more severe illnesses.
Utah should focus efforts on improving its Medical Liability Environment by providing additional liability protections for EMTALA-mandated emergency care and reducing the medical liability cap on non-economic damages. Doing so may help attract and retain more physicians and encourage more specialists to provide on-call services for emergency patients.
Investing further in Disaster Preparedness planning and infrastructure would improve the state’s grade in this category significantly. The state should prepare plans for special needs patients, including plans to supply medications for chronic conditions or dialysis to patients during a disaster. Instituting patient and victim tracking systems also would enhance preparedness throughout the state.