Wyoming receives a failing grade in Public Health and Injury Prevention, and near-failing grades for the Quality and Patient Safety and Medical Liability Environments, but there’s good news as well, ranging from the state’s trauma system to its commitment to protecting access to care for Medicaid patients.
Strengths. Wyoming has invested considerable resources in developing, implementing, and overseeing a statewide, inclusive trauma system to address the unique needs and issues facing a frontier state. Some successes related to these efforts include a statewide Web-based trauma registry, a stroke system of care, a funded state EMS medical director position, and a uniform system for providing pre-arrival instructions. In addition, Wyoming supports the second highest Medicaid reimbursement rates for office visits in the nation (162.7 percent of the national average). Wyoming also is successful with regard to hospital capacity, ranking among the top five states for high rates of emergency departments (48.8 per 1 million people), staffed inpatient beds (503.0 per 100,000), and psychiatric care beds (54.8 per 100,000).
Wyoming has made some noteworthy strides in Disaster Preparedness planning and infrastructure development. The state has a real-time notification system in place to notify identified health care providers of an event, as well as a statewide “just-in-time” training system, and a medical communication system with one layer of redundancy. The state also has an all-hazards medical response plan and a written plan for special needs patients. These successes may be due in part to the relatively high rate of federal funding for disaster preparedness that the state receives ($25.96 per capita).
Challenges. Wyoming is lacking with regard to the Quality and Patient Safety Environment for a number of reasons. The state lacks funding for quality improvement within the EMS system, and only 83.3 percent of counties in Wyoming have Enhanced 911 capability. At the time these data were collected, only 12.0 percent of hospitals used electronic medical records and none used computerized practitioner order entry. These numbers already have increased, however, since Memorial Hospital of Sweetwater County in Rock Springs has implemented such systems, setting a positive example for hospitals throughout the state.
Wyoming also receives poor scores on a number of Public Health and Injury Prevention indicators. The state has the nation’s highest rates of traffic fatalities (37.9 per 100,000 people) and fatal occupational injuries (149.6 per 1 million workers). Only 72.2 percent of front occupants use seat belts, compared with the national rate of 82 percent. Wyoming also has a relatively low percentage of children aged 19-35 months who are immunized (75.5 percent).
Wyoming’s grade in the Medical Liability Environment is the result of its failure to institute a number of liability reforms. The state lacks a medical liability cap on non-economic damages and case certification by an expert witness. Reflective of this environment, the state has the fourth highest average malpractice award payment in the nation ($427,762).
While Access to Emergency Care in Wyoming fares better overall than the majority of states, it still faces critical workforce issues, including a severe lack of plastic surgeons and ear, nose, and throat specialists (0.8 and 2.5 per 100,000 people, respectively). In addition, while the state ranks fifth for the rate of Level I or II trauma centers (3.8 per 1 million people), only 32.3 percent of the population live within 60 minutes of a Level I or II trauma center.
Recommendations. Wyoming must address numerous concerns related to Public Health and Injury Prevention indicators. The state should consider passage and enforcement of a primary seat belt law, which could help increase seat belt use and decrease overall traffic fatalities. The state also might investigate and implement interventions designed to address the exceptionally high rate of fatal occupational injuries, which is higher than other geographically similar states.
Wyoming also might consider implementing medical liability reforms to attract a broader health care workforce by providing additional liability protections for EMTALA-mandated emergency care or requiring expert witnesses to be of the same specialty as the defendant.
Finally, Wyoming should consider funding an EMS quality improvement program and instituting hospital-based infections reporting requirements to improve its Quality and Patient Safety Environment.