Emergency Care Report Card: America Earns a C-

WASHINGTON – The state of emergency care in America received low marks in a report released Jan.10 by an objective panel of emergency medical experts. The first-ever National Report Card on the State of Emergency Medicine finds an emergency care system characterized by overcrowding, declining access to care, soaring liability costs and a poor capacity to deal with public health or terrorist disasters.

The nation’s emergency medical care system received an overall grade of C-, which represents the average of grades for all 50 states and the District of Columbia. A task force of experts assembled by the American College of Emergency Physicians (ACEP) used a range of available data to develop 50 measures for grading each state on a scale of A through F for its support in four areas: access to emergency care, quality and patient safety, public health and injury prevention, and medical liability environment.

“Americans assume they will receive lifesaving emergency care when and where they need it, but increasingly this isn’t the case,” said Frederick C. Blum, MD, FACEP, president of ACEP. “Our report found the nation’s support for emergency medical care is mediocre or worse. Most Americans would not accept mediocre treatment or mediocre medicines; they also should not accept mediocre support of an emergency medical system they expect to be of the highest quality when their lives hang in the balance. In a nation that has prided itself on providing the highest-quality medical care in the world, anything less than an A is unacceptable.”

While no state received an overall A grade, California ranked first in the nation, followed by Massachusetts, Connecticut, and the District of Columbia, all earning the highest overall B grades. The report found that half the states were providing below-average support for their emergency medical systems, earning poor or near-failing grades. Arkansas, Idaho and Utah had the weakest support, receiving the worst overall grade of D.

The report card provides local, state and federal officials with information to identify their states’ strengths and areas for improvement, while allowing them to make comparisons and learn from other states. The task force analyzed data from sources including the American Medical Association, the American Nurses Association, the Henry J. Kaiser Family Foundation and the U.S. Department of Health and Human Services, among others. A task force of emergency physicians applied the grades by considering 50 measurements that were common to all states. A curved grading system was used, applying grades by comparing each state with the highest-ranked state in each category.

“This report is a serious wake-up call to the nation,” said Angela Gardner, MD, FACEP, a practicing emergency physician in Texas and chair of ACEP’s Report Card Task Force. “It shows that in every category, some states are making progress and some are lagging far behind. If the emergency medical system gets a C- on an average day, how can it ever be expected to provide expert, efficient care during a natural disaster or terrorist attack? Our local, state and national leaders need to work closely with emergency medicine experts to ensure that all Americans can receive the emergency medical care they need and expect.”

Specific findings from the Report Card include:

  • Access to Emergency Care
    Seven states led the nation, earning “A” grades in the category – Connecticut, the District of Columbia, Maine, Massachusetts, Ohio, Pennsylvania and Rhode Island – with no state receiving a failing grade. The category looked at the availability of emergency care resources, as well as certain kinds of state health spending, including public funding of health insurance, which makes more resources available to everyone. Nine states received D grades: Alabama, Arkansas, Arizona, Georgia, Idaho, Nevada, New Mexico, Texas and Utah.
  • Quality of Care and Patient Safety
    Eight states led the nation, earning “A” grades in this category – Connecticut, Delaware, District of Columbia, Georgia, Iowa, New Jersey, Pennsylvania and West Virginia. Three states received “F” grades – Kansas, Nevada and South Dakota – and 17 others earned “D” grades. This category looked at state support for training emergency physicians and EMS personnel as well as patient access to ambulances and 911 services.
  • Public Health and Injury Prevention
    Earning “A” grades in this category were California, Maryland, Massachusetts, Michigan and New York. Forty-one states earned a “C” or lower in support for health and safety programs, with two states, with Montana and South Dakota, earning “F” grades. This category focused on lessening the need for emergency care due to traumatic injury or preventable illnesses. It looked at indicators, such as whether the state had seat belt and helmet laws, domestic violence programs, as well as state immunization rates and the number of mothers receiving prenatal care.
  • Medical Liability Environment
    California, Montana, Nevada and Texas earned “A” grades. Twelve states received failing grades for their medical liability environments – Arkansas, Connecticut, District of Columbia, Maryland, New Jersey, North Carolina, Pennsylvania, Rhode Island, Tennessee, Vermont, Virginia and Wyoming – while 30 others had near failing grades. This category assessed increases in state medical liability rates as well as reform initiatives. Problems with a state’s medical liability climate can lead to physician shortages, delays in patient care and increased patient transfers.

Although the report card found a general correlation between the overall wealth of a state and better grades, it also found that some of the nation’s historically poorest states earned better-than-average grades – South Carolina and West Virginia – demonstrating their commitment to high-quality emergency care. They also discovered that states with lower population densities generally faced greater deficits in emergency care.

“As emergency physicians providing care to millions of Americans each year, my colleagues and I knew the environment for consistently providing quality, timely emergency care was eroding, but even we weren’t prepared for how dire the situation is in some states,” said Dr. Blum. “The important thing to remember is that in virtually every category we considered, at least one state is doing an excellent job. These models can be analyzed and adapted to improve emergency care for everyone, regardless of what state one lives in.”

ACEP officials say they will continue to measure state efforts and improvements in emergency care over time, using this report as an initial benchmark.

To check your state’s grades, go to ACEP’s Web site at http://www.acep.org/webportal.

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