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Grading the Report Card
John McConnell, who was on yesterday's ER report card show, wrote us an e-mail after the program to clarify his thoughts on the report:
The ACEP report card is useful in identifying some important challenges for emergency medicine. There are a lot of things we could do better in Oregon -- covering the uninsured and legislation to support statewide EMS coordination would be helpful. But there are some problems with the ACEP report that may have resulted in a lower grade than Oregon should have received. I list a few here:
- Oregon gets downgraded for having the third lowest rate of staffed inpatient beds. But many respected health policy experts and a lot of published evidence suggests that more inpatient beds often results in higher costs without better outcomes. And they have often pointed to Oregon as a model of efficiency.
- Some of their numbers are wrong; the report states that we have 1.3 Level I or Level II trauma centers per 1M residents, but really we have about twice that many.
- The report also downgrades us for a decrease in emergency departments since 2006, but no EDs have closed over that period of time.
- The report downgrades us for not requiring a hospital-based infection reporting system, but those laws are in place and the system goes into effect in January.
Some of the things that Oregon didn't appear to get credit for include having a mature trauma system that just celebrated 30 years (there is a large body of research demonstrating the survival benefit to implementation of the Oregon Trauma System), an excellent emergency medicine residency program, and very good outcomes for at least some emergency conditions (such as cardiac care). In addition, even though there may be some unnecessarily and unfortunately long wait times in some ERs in Oregon, we are not experiencing some of the horror stories that exist in some hospitals in the country -- 50 patients in the waiting room, 15 hour waits, beds in the halls.
This is not to suggest that there is not room for improvement, only that there are limitations to the report and Oregon may have been unfairly scored on some categories. Nonetheless, there are clearly areas where we could improve, including reducing the uninsured and greater support for the state EMS system.
I'll send this post to the folks at ACEP, and let you know if they respond.