Colorado continues to rank first in the nation for its Medical Liability Environment and has improved from 13th to 5th for its overall emergency care environment since 2009. However, some serious concerns remain with regard to Access to Emergency Care, including high rates of uninsured and underinsured adults and children and the need for greater access to behavioral health care.
Colorado continues to lead the nation in its Medical Liability Environment, having implemented and maintained legislation that allows health care providers to issue apologies to patients without those statements being admissible as evidence of wrongdoing; maintaining expert witness rules that provide for case certification and require expert witnesses to be of the same specialty as the defendant and licensed to practice medicine in the state; and allowing malpractice awards to be offset by collateral sources. The state has maintained its $300,000 cap on non-economic damages despite continuous efforts to increase it.
In Public Health and Injury Prevention, Colorado has some of the lowest obesity rates for adults and children (20.7 and 10.9%, respectively) and relatively high rates of influenza and pneumococcal vaccinations among older adults (65.9 and 75.8%, respectively). The state also has low rates of adult cigarette smoking (18.3%), supported by legislation that prohibits smoking in restaurants, bars, and private worksites.
While dropping eight places since 2009, Colorado maintains some noteworthy practices in Disaster Preparedness. Its medical response plan specifically addresses patients with special needs, patients dependent on medication for chronic conditions, and mental health patients. Colorado is one of only five states to require training in disaster management and response to biological and chemical terrorism for essential hospital and emergency medical services personnel. Since the previous Report Card, Colorado has become accredited by the Emergency Management Accreditation Program.
Colorado continues to face critical issues in Access to Emergency Care, especially related to financial barriers to care and behavioral health capacity. Colorado continues to have one of the highest rates of uninsured people, and even those who have health insurance face financial barriers to receiving care: 17.4% of adults and 10.4% of children in Colorado lack health insurance, while an additional 8.4% of adults and 19.7% of children are underinsured.
Access to behavioral health care is a major barrier in Colorado, which has the second highest proportion of adults reporting an unmet need for substance abuse treatment (10.7%) and the lowest rate of psychiatric care beds (5.5 per 100,000 people) in the nation. Adding to this the sixth lowest rate of staffed inpatient beds (226.7 per 100,000 people), the state faces challenges in addressing emergency department boarding and crowding.
While Colorado has improved slightly in the Quality and Patient Safety Environment, the state is still lacking in many respects. It does not have a uniform system for providing prearrival instructions and scored below average in the percentage of hospitals with electronic medical records (89.7%). Additionally, while Colorado has triage and destination policies in place for trauma patients, it lacks similar policies to enhance the timeliness and quality of care for stroke and ST-elevation myocardial infarction (STEMI) patients.
Financial barriers to care continue to be a major burden on Colorado's people and weaken the state's overall system of emergency care. Colorado must take steps to ensure that all people not only have health insurance but the capability to obtain the care that they need when they need it. The state also should improve access to substance abuse treatment and work with hospitals to increase capacity related to psychiatric care beds and staffed inpatient beds. Financial barriers to care continue to burden Colorado's people and the overall system of care.
To improve Colorado's Quality and Patient Safety Environment, efforts should be made to implement triage and destination policies for STEMI and stroke patients; however, the stroke and STEMI system effort is concentrated outside of state government and statewide regulatory functions, which may pose challenges to improving the overall system of emergency care. The state also should work with and encourage hospitals to collect data on race, ethnicity and primary language and to develop a diversity strategy or plan, as these are the first steps in being able to examine and address health inequities.
Despite overall high performance in Public Health and Injury Prevention, Colorado must work to reduce racial and ethnic disparities in cardiovascular disease and infant mortality rates in its population. The state should address the high rate of binge drinking reported among adults (20.1%), a proportion that has increased considerably since 2009. Colorado could further improve traffic safety in the state by instituting more rigorous graduated driver's license laws, requiring all motorcycle riders to use helmets, and passing a ban on all cellphone use while driving.