01/16/2014 11:11 am ET Updated Jan 25, 2014

2014 State Rankings Released For Support For Emergency Care

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Government support for emergency care in the United States is worse now than it was five years ago, according to a new report from the American College of Emergency Physicians.

In 2009, the grade given for government policy support for emergency care was a C-. In 2014, the grade has dropped to a D+.

The report analyzed state and government support for emergency care based on a number of categories: access to emergency care, disaster preparedness, quality and patient safety environment, medical liability environment, and public health and injury prevention. Grades for each of these categories either stayed the same or worsened from 2009 to 2014.

For instance, access to emergency care scored a D- in the new report. "The national grade for Access to Emergency Care remains a D- as states continue to struggle with a plethora of issues, including health care workforce shortages, shortages of on-call specialists, limited hospital capacity to meet the needs of patients, long emergency department wait times, and increasing financial barriers to care," according to the report.

Meanwhile, quality and patient safety environment was one of the better-performing categories, even though the score went down to a C this year from a C+ in 2009.

"Part of this decline is related to the addition of new indicators that allow better measurement of the true quality and patient safety environment," the authors of the report wrote. "For instance, while hospitals have greatly increased adoption of electronic medical records (92.0%) and computerized practitioner order entry (77.1%) since 2009, they lag in developing diversity strategies or plans (44.0%) and efforts to collect data on patients’ race and ethnicity and primary language (58.6%)."

The nation's score for medical liability environment was a C- in 2014, which was unchanged from 2009. But "while this indicates that the nation has failed to make progress, it does not mean nothing has changed. Since the previous Report Card, a number of states have seen liability reforms declared unconstitutional, and there are constant challenges to rules already in place in many other states," the authors wrote in the report. "While the overall grade may mask these serious problems, a few states, such as North Carolina, saw great success in improving its medical liability environment, which prevented the national grade from declining."

The report also looked at each state's support of emergency care, and issued a ranking based on the findings. Grades were issued in relation to the grades of other states, and so "are not an absolute measure of a state's support for its emergency care system." In addition, the grades are not meant to be an indicator of the quality of care provided by hospitals or other providers.

The nation again scored a C for public health and injury prevention -- the same as in 2009 -- which the study's authors noted was a result of gains and setbacks in preventive actions. For instance, the proportion of children receiving immunizations, as well as the proportion of older adults getting their flu shots, has decreased.

The national grade for disaster preparedness was a C- in 2014, which fell from the C+ grade in 2009. There have been decreases in federal funding for disaster preparedness over the last five years. On the bright side, there has been an increase in how many health professionals have registered to be in the Emergency System for Advance Registration of Volunteer Health Professionals.

The report also ranked states based on support for emergency care based on the same five criteria:

Top states for emergency care
1. District of Columbia
2. Massachusetts
3. Maine
4. Nebraska
5. Colorado
6. Pennsylvania
7. Ohio
8. North Dakota
9. Utah
10. Maryland

Worst states for emergency care
51. Wyoming
50. Arkansas
49. New Mexico
48. Montana
47. Kentucky
46. Michigan
45. Illinois
44. Alabama
42. Louisiana
42. Alaska