While Missouri can boast of substantial achievements in its disaster planning efforts, significant progress is needed to improve traffic safety and reduce other accident-related fatalities.
Strengths. Missouri’s grade in Disaster Preparedness is due to a wide range of planning and coordination activities at the state level. Missouri has an all-hazards medical response plan, as well as a written plan specifically for patients with special needs. The state has real-time notification and syndromic surveillance systems, “just-in-time” training, a statewide medical communication system with one layer of redundancy, and liability protections for health care workers in the event of a disaster. Missouri also ranks among the top five states for per capita burn unit beds and ICU beds. The state has the third highest rate of nurses registered in the state-based Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) program, though the state lacks any physicians registered with ESAR-VHP.
While Missouri did not score exceptionally well with regard to Access to Emergency Care, the state’s relatively high capacity for care is worthy of mention. The state ranks second in the nation for the high rate of psychiatric care beds and sixth for accredited chest pain centers. Missouri has higher-than-average rates of staffed inpatient beds, as well as a relatively low daily hospital occupancy rate. The state also has high rates of neurosurgeons, plastic surgeons, and registered nurses per capita, compared to the nation as a whole.
Challenges. Missouri’s poorest showing is in the area of Public Health and Injury Prevention, where the state is ranked 42nd in the nation. Missouri ranks 37th for traffic fatalities, 40th for seat belt use, and 41st for the percentage of traffic fatalities that are alcohol-related. The state also ranked poorly for its relatively high rates of fatal unintentional injuries due to fires or burns (40th), falls (38th), and firearms (37th). Similarly, the rates of homicides and suicides and fatal occupational injuries were also relatively high. Missouri’s infant mortality rate is 7.5 deaths per 1,000 live births, compared to a rate of 6.9 per 1,000 live births nationally. The obesity rate is also higher than the nation as a whole (27.2 versus 25.1 percent, respectively), as is the proportion of adults who smoke cigarettes (23.2 versus 20.1 percent).
The Quality and Patient Safety Environment in Missouri shows a mixed picture. While the state does have a funded EMS medical director position, there is no funding for quality improvement within the EMS system. Similarly, while a stroke system of care and a PCI network or STEMI system of care are being implemented, Missouri lacks a uniform system for providing pre-arrival instructions. Hospital-based infections reporting is required by the state, but there is no mandatory quality reporting requirement.
Although Missouri has considered multiple medical liability reforms, not all have been enacted. Missouri has partially abolished joint and several liability, provides for case certification by an expert witness, and allows for periodic payments of malpractice awards at the request or agreement of one or both parties to the suit. However, the state does not have additional liability protections for EMTALA-mandated emergency care, requirements regarding the specialty or licensing of expert witnesses, or pretrial screening panels.
Recommendations. Regarding the state’s grade in Public Health and Injury Prevention, Missouri could see significant improvements through greater investment in injury prevention and health promotion activities to encourage positive lifestyle changes, such as smoking cessation and prevention, healthy eating, physical activity, and increased seat belt use. There is also a need to create further quality improvement and monitoring systems, enact additional liability reforms, and increase the number of physicians registered in ESAR-VHP. In addition, the state would benefit from strategies to increase the recruitment and retention of medical specialists and specialty service providers, particularly in the areas of mental health and substance abuse.