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.
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.
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).
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.