Measuring Preparedness

Healthcare
Delivery

National
Confidence Interval
4.6 - 5.1
National
Preparedness Level
4.9

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 in the state
Measure Name

M140

Measure Source

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

Data date(s)

2012 - 2017

Limitations

The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

m331
Percent of local emergency medical services (EMS) agencies that submit National EMS Information System (NEMSIS) compliant data (e.g., Version 2 in earlier years, Version 3 in later years) 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)

2015 & 2019

Limitations

The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.

m349
State has adopted EMS Personnel Licensure Interstate CompAct (REPLICA) legislation
Measure Name

M349

Measure Source

National Association of State EMS Officials

Data date(s)

2013 - 2018

Limitations

Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.

m350u
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in urban areas.
Measure Name

M350U

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015 - 2017

Limitations

Selected states fail to record response times for all fatal events.

m350r
The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in rural areas.
Measure Name

M350R

Measure Source

National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)

Data date(s)

2015 - 2017

Limitations

Selected states fail to record response times for all fatal events.

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 hospital emergency department (ED) arrival to ED departure for patients admitted to hospitals in the state (identifier ED-1)
Measure Name

M147

Measure Source

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

Data date(s)

2013 - 2018

Limitations

The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.

m148
Median time in minutes from hospital admission decision to emergency department (ED) departure for patients admitted to hospitals in the state (identifier ED-2)
Measure Name

M148

Measure Source

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

Data date(s)

2013 - 2018

Limitations

The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.

m152
Percent of the state's population who live within 50 miles of a trauma center, including out-of-state centers
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)

2012 - 2017

Limitations

The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.

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

M160

Measure Source

U.S. Census, American Community Survey

Data date(s)

2012 - 2017

Limitations

The measure does not consider mutual aid plans that may be in place for healthcare facilities to supplement the number of available physicians and surgeons in the event of an emergency. Also, BLS and other national data sources on physician supply have been shown to undercount certain types of physicians, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

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

M167

Measure Source

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

Data date(s)

2013-2016, 2018 & 2019

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.

m168
Percent of the state's population living within 100 miles of a burn center, including out-of-state centers
Measure Name

M168

Measure Source

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

Data date(s)

2014 & 2018

Limitations

The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.

m296
Percent of hospitals in the state providing a specialty geriatric services program (includes general as well as specialized geriatric services, such as psychiatric geriatric services/Alzheimer care)
Measure Name

M296

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012 - 2017

Limitations

The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.

m297
Percent of hospitals in the state providing 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)

2012 - 2017

Limitations

The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.

m298
Number of hospital airborne infection isolation room (AIIR) beds per 100,000 population in the state, 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)

2012 - 2017

Limitations

The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.

m299
Risk-adjusted 30-day survival rate (percent) among Medicare beneficiaries hospitalized in the state 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)

2011-2013, 2015 & 2016

Limitations

Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.

m300
Percent of hospitals in the state with a top quality ranking (Grade A) on the Hospital Safety Score
Measure Name

M300

Measure Source

The Leapfrog Group, Hospital Safety Score (HSS)

Data date(s)

2013 - 2018

Limitations

The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. 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.

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
m308
Average number of nurse (RN) staffing hours per resident per day in nursing homes in the state
Measure Name

M308

Measure Source

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

Data date(s)

2014 - 2018

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

m309
Average number of nursing assistant (CNA) staffing hours per resident per day in nursing homes in the state
Measure Name

M309

Measure Source

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

Data date(s)

2014 - 2018

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

m307
Percent of long-stay nursing home residents in the state that are 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 - 2018

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on healthcare facilities may be marginal in the event of a major disaster.

m310
Average number of licensed practical nurse (LPN) staffing hours per resident per day in nursing homes in the state
Measure Name

M310

Measure Source

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

Data date(s)

2014 - 2018

Limitations

The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.

m303b
Number of licensed skilled nursing facilities with deficiencies in compliance with CMS Emergency Preparedness requirements, per 100 facilities in the state (expressed as quintiles)
Measure Name

M303B

Measure Source

CMS Nursing Facility Inspection Reports

Data date(s)

2014 - 2018

Limitations

Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.

m23nh
Number of disease outbreaks in nursing homes or assisted living facilities per 1,000 certified nursing home residents in a state
Measure Name

M23NH

Measure Source

Centers for Disease Control and Prevention (CDC), National Outbreak Reporting System (NORS)

Data date(s)

2012 - 2017

Limitations

States vary in their ability to detect and report outbreaks in long-term care settings.

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
m316
Percent of hospitals in the state providing psychiatric emergency services
Measure Name

M316

Measure Source

American Hospital Association (AHA), Annual Survey of Hospitals

Data date(s)

2012 - 2017

Limitations

The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.

m317
Percent of need met for mental health care in health professional shortage areas (HPSA) 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 - 2018

Limitations

The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.

m800
Percent of the state's population not living in an HRSA 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 - 2017, 2019

Limitations

The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.

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
Percent of home health episodes of care in the state where the home health team determined whether their patient received a flu shot for the current flu season
Measure Name

M291

Measure Source

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

Data date(s)

2013 - 2018

Limitations

Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on healthcare facilities may be marginal in the event of a major disaster.

m292
Percent of home health episodes of care in the state where the home health team began their patients' care in a timely manner
Measure Name

M292

Measure Source

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

Data date(s)

2013 - 2018

Limitations

The measure does not evaluate the quality of the services provided including length of service delays.

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

M293

Measure Source

American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)

Data date(s)

2012 - 2017

Limitations

The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.