Measuring Preparedness

Healthcare
Delivery

National
Confidence Interval
4.9 - 5.6
National
Preparedness Level
5.3

What it Means

Actions to ensure access to high quality medical services across the continuum of care during and after disasters and emergencies.

How we Measure it

Healthcare Delivery Sub-domains

pc: prehospital care

hps: hospital and physician services

ltc: long term care

mbh: mental behavioral healthcare

hc: home care

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Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between healthcare facilities.

Measure
Measure Description
Source
m140
Number of emergency medical technicians (EMTs) and paramedics per 100,000 population
Measure Name

M140

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012 - 2015

Limitations

The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated.

m331
What percentage of the state's local emergency medical services (EMS) agencies submit National EMS Information System (NEMSIS) compliant data to the state?
Measure Name

M331

Measure Source

National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information

Data date(s)

2014 - 2016

Limitations

Some states may collect local and regional EMS data that provide some of the data in the national data set. These states may have the capability to conduct limited quality improvement and process improvement activities, but will be unable to compare themselves to national data.

Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.

Measure
Measure Description
Source
m147
Median time in minutes from emergency department (ED) arrival to ED departure for admitted ED patients (identifier ED-1)
Measure Name

M147

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care - State

Data date(s)

2013 - 2016

Limitations

There is unknown information about the nature of treatment between emergency department arrival and discharge.

m148
Median admit decision time in minutes to emergency department (ED) departure time for admitted patients (identifier ED-2)
Measure Name

M148

Measure Source

Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care - State

Data date(s)

2013 - 2016

Limitations

The measure describes the pre-event capability to move patients from the emergency department to inpatient care but it does not describe the hospital's capabilities during a mass casualty or other event.

m149
Number of staffed beds per 100,000 population
Measure Name

M149

Measure Source

American Hospital Directory (AHD), Inc. American Hospital Directory

Data date(s)

2013 - 2016

Limitations

The measure does not include the total licensed beds for which a healthcare facility maintains a license to operate. The measure also does not consider plans for creating additional beds through hospital surge plans.

m152
Percentage of a state's population who live within 50 miles of a trauma center (including trauma centers from neighboring states)
Measure Name

M152

Measure Source

American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.

Data date(s)

2011 - 2013

Limitations

The quality of care provided by the trauma centers is not considered in this measure.

m160
Number of physicians and surgeons per 100,000 population
Measure Name

M160

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)

Data date(s)

2012 - 2015

Limitations

This measure may not reflect that healthcare facilities and jurisdictions may have mutual aid plans in place to supplement the number of physicians and surgeons in the event of an emergency. Also, BLS and other national data sources on physician supply have been shown to under-count certain types of physicians. Specifically, BLS estimates may differ considerably from the estimates available from state medical licensing boards. These measurement errors in the national BLS data are expected to be relatively consistent across states, and therefore they should not cause significant bias in the Index state and national results.

m167
Number of active registered nurse (RN) and licensed practical nurse (LPN) licenses per 100,000 population
Measure Name

M167

Measure Source

National Council of State Boards of Nursing (NCSBN), National Nursing Database

Data date(s)

2013 - 2016

Limitations

The measure may underrepresent the number of RNs or LPNs available to surge to provide care during an emergency. States that do not participate in the National Council of State Boards of Nursing include Alaska, Hawaii, and Oklahoma. Louisiana does not report data regarding PNs. Further, mutual aid protocols may exist to bring additional RNs and PNs into the jurisdiction to respond to an emergency requiring medical surge.

m168
Percent of population who live within 100 miles of a burn center (includes burn centers in other states)
Measure Name

M168

Measure Source

American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.

Data date(s)

2014

Limitations

The measure may underrepresent the specialized resources needed for an emergency that requires mass care of burn patients.

m296
Percentage of hospital facilities in the state that provide geriatric services (includes general as well as specialized geriatic services, such as psychiatric geriatric services/Alzheimer care)
Measure Name

M296

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2011 - 2013

Limitations

The measure considers geriatric services that are owned or provided by the hospital or by the hospital's health system (i.e., doesn't require a contractual agreement). Hospitals may provide competent care to geriatric patients without having a specialty care program.

m297
Percentage of hospital facilities in the state that provide palliative care programs (includes both palliative care program and/or palliative care inpatient unit, but excludes pain management program, patient-controlled analgesia, and hospice program)
Measure Name

M297

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2011 - 2013

Limitations

The measure only evaluates whether or not a hospital provides the service. The quality of care and the capacity of the program to provide services during an emergency are not considered.

m298
Number of airborne infection isolation room (AIIR) beds per 100,000 population (including hospitals with AIIR rooms within 50 miles from neighboring states)
Measure Name

M298

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2011 - 2013

Limitations

There are no obvious limitations to this measure.

m299
Risk-adjusted 30-day mortality among Medicare beneficiaries hospitalized for heart attack, heart failure, or pneumonia
Measure Name

M299

Measure Source

The Commonwealth Fund, Aiming Higher: Results from a Scorecard on State health System Performance

Data date(s)

2008-11, 2009-12, 2010-13

Limitations

Variations in state populations (e.g., obesity or smoking rates) may have a greater effect on this measure than public health programs, mitigating the measure's use for this purpose.

m300
Percentage of grade "A" hospitals in a state for Hospital Safety Score
Measure Name

M300

Measure Source

The Leapfrog Group, Hospital Safety Score (HSS)

Data date(s)

2013 - 2016

Limitations

More than 2,600 hospitals received a score. Hospitals excluded from receiving a score include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others.

m906
The percentage of short-term general and Critical Access hospitals that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare and Medicaid EHR Incentive Programs. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
Measure Name

M906

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013 - 2015

Limitations

This is a survey estimate.

m907
The percentage of all office-based medical doctors and doctors of osteopathy that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare and Medicaid EHR Incentive Programs.
Measure Name

M907

Measure Source

The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services

Data date(s)

2013 - 2015

Limitations

This is a survey estimate.

Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.

Measure
Measure Description
Source
m303
State requires that long-term care and nursing home facilities must have a written disaster plan
Measure Name

M303

Measure Source

American College of Emergency Physicians (ACEP), America's Emergency Care Environment, A State-by-State Report Card

Data date(s)

2013

Limitations

The measure does not evaluate the quality or feasibility of the emergency preparedness plan. Simply having a plan is a not enough; it is the quality and detail of the plan and actively planning with the community that provides a deeper context. Also, according to state public health personnel in Vermont, this 2013-2014 data source does not accurately reflect that state's administrative regulations dating to 2000-2001. The ACEP Report indicates that Vermont does not require a written disaster plan for long-term care and nursing home facilities, but in fact this was a requirement when the ACEP Report was published. We have changed Vermont's item measure value for M303 from "0" to "1" according to this feedback.

m308
State average reported registered nurse (RN) staffing hours per resident per day
Measure Name

M308

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014 - 2016

Limitations

The measure is an average that does not include more detail on the range/distribution, thus limiting its descriptive value. Data are collected during a specific two-week period; variations related to season, region, resident acuity, skill mix of other care providers, and other factors are not taken into account.

m309
State average reported certified nursing assistant (CNA) staffing hours per resident per day
Measure Name

M309

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014 - 2016

Limitations

The CNA capacity in a state does not guarantee that they are available during a disaster. Those CNAs that are available also need to have disaster-specific education.

m307
Percent of long-stay residents assessed and appropriately given the seasonal influenza vaccine
Measure Name

M307

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2013 - 2016

Limitations

The additional protection gained and the reduced demand on the healthcare system is of some value but may be marginal in the context of a major disaster. Also, the effectiveness of the vaccine varies as a function of the accuracy in predicting the strains used to make each year's vaccine.

m310
State average reported licensed practical nurse (LPN) staffing hours per resident per day
Measure Name

M310

Measure Source

Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages

Data date(s)

2014 - 2016

Limitations

The measure is an average that does not include more detail on the range/distribution, thus limiting its descriptive value. Data are collected during a specific two-week period; variations related to season, region, resident acuity, skill mix of other care providers, and other factors are not taken into account.

Mental and behavioral healthcare is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.

Measure
Measure Description
Source
m315
Percentage of hospital facilities in the state that provide chaplaincy/pastoral care services
Measure Name

M315

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2011 - 2013

Limitations

Chaplaincy/pastoral care services may not be available in adequate numbers to respond to a surge and services are not solely focused on fatalities.

m316
Percentage of hospital facilities in the state that provide psychiatric emergency services
Measure Name

M316

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2011 - 2013

Limitations

Respondents to the American Hospital Association (AHA) survey (the source for this measure) may have varying definitions of emergency psychiatric services covering a broad range. In effect, all hospitals that provide emergency medical services provide emergency psychiatric services. At the same time, fewer may have more complete, specialty-staffed, comprehensive psychiatric emergency services. Positive responses to this measure will cover a very wide range of capability. A negative may reflect the complete absence of emergency psychiatric services or the respondent's view that a positive response requires a separate, identifiable, comprehensive service when, in fact, some capacity exists. The measure does not indicate the extent of the hospital's or emergency psychiatric services integration with other disaster preparedness and response efforts (including health). It does not measure the type of services provided such as at hospital, mobile crisis response capacity, telephone-based crisis services, etc. In some cases, this measure may tend to duplicate and/or overlap with another measure that asks about licensing and certification of behavioral health and substance abuse providers.

m317
Percentage of need met in mental health professional shortage areas in the state
Measure Name

M317

Measure Source

The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA)

Data date(s)

2014 & 2016

Limitations

This measure is based solely on the availability of psychiatrists. While psychiatrists often play an important role in the array of services provided following disasters, the vast majority of behavioral health services following disasters are provided by behavioral health professionals other than psychiatrists (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses). The extent to which this measure serves as a proxy for shortages in these other professional groups will likely vary across jurisdictions. The measure does not account for the ability of a state to temporarily move mental health resources within the state in times of disasters. For example, many states have established trained and certified crisis teams that can be activated and deployed to disaster zones, thus enabling rapid supplementation of local resources. The measure does not reflect the availability of existing resources (many providers have waiting lists and/or are legally and contractually obligated to serve particular populations and may not be available for alternative service in times of disasters). The measure does not reflect the status of skills and training necessary for optimal performance in disasters.

m800
Population (% of state total) living in a HRSA-designated Mental Health Professional Shortage Area
Measure Name

M800

Measure Source

U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.

Data date(s)

2015 & 2016

Limitations

While this measure has no apparent limitations, it can be difficult to estimate.

Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.

Measure
Measure Description
Source
m291
How often the home health team determined whether the patient received a flu shot for the current flu season as an average percentage of home health episodes of care in the state
Measure Name

M291

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2013 - 2016

Limitations

How often average percentage of home health episodes of care in the state the home health team determined whether the patient received a flu shot for the current flu season as an average percentage of home health episodes of care in the state is not in itself useful to determine population-level health resiliency.

m292
How often the home health team began their patients' care in a timely manner as an average percentage of home health episodes of care in the state
Measure Name

M292

Measure Source

Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data

Data date(s)

2014 - 2016

Limitations

The measure is a statewide average and does not indicate the lengths of delays, nor does it identify if this is a regional or statewide problem. These issues limit the usefulness of the measure.

m293
Number of home health and personal care aides per 1,000 population aged 65 or older
Measure Name

M293

Measure Source

American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel.

Data date(s)

2012 - 2015

Limitations

The number of home health and personal care aides per 1,000 population aged 65 and older gives an indication of the total capacity of home health aides available. However, that information in itself does not describe their availability during a health emergency or the number of providers that have emergency care plans for their clients.