Hospitals Get a 'C' In Palliative Care

Hospitals are rapidly adding palliative care services, but their availability is widely disparate, according to a report that gave a grade of “C” to the state of palliative care services in the nation's hospitals.

Overall, 53% of U.S. hospitals with 50 or more beds reported offering palliative care, according to the report card that was compiled by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC), which is based at Mt. Sinai School of Medicine in New York.

But geographic access varies widely, the report found. In three states—Alabama, Mississippi, and Oklahoma—10%–20% of hospitals offer palliative care. In Vermont, every hospital offers the service. The results were published online in the Journal of Palliative Medicine (2008 Oct. 2 [doi:10.1089/jpm.2008.0053]).

Hospitals were graded on patient access to palliative care services, patient access to board-certified palliative medicine specialists, medical student access to clinical training in palliative medicine, and physician access to specialty-level training in the field. The report is based on the American Hospital Association's 2006 Annual Survey Database and a more recent survey that was mailed to hospitals by the CAPC.

The report excluded rehabilitation, psychiatric, and pediatric hospitals. Children's hospitals were excluded because many pediatric palliative care programs are within general acute care facilities and there was no way to distinguish them, Dr. R. Sean Morrison, director of the NPCRC, said in an interview. Veterans Affairs hospitals also were excluded because the government requires every VA facility to offer palliative care, said Dr. Morrison, a coauthor of the report.

Hospitals with more than 300 beds were most likely to have palliative care, with 75% reporting a program. Nonprofit hospitals and hospitals affiliated with a medical school also were more likely to offer a palliative program.

Only 20% of for-profit hospitals report offering palliative care. Dr. Morrison said he was not sure why programs were few and far between at these facilities.

Palliative care is offered in 41% of public hospitals and 29% of sole community provider hospitals, creating a disparity of access for many urban, rural, and isolated areas, Dr. Morrison said.

The Midwest had the highest prevalence of hospitals with palliative care programs (65%), followed by the Northeast and the West. In the South, only 41% of hospitals offer palliative care.

There were some exceptions to the general trends. Montana, a largely rural state, had the second-highest prevalence, with 88% of hospitals offering palliative care. Dr. Morrison said that one of the pioneering palliative care programs was started in the state, which might explain why so many Montana hospitals have palliative care.

The report also pointed out a need for palliative care training to meet the needs of an estimated 90 million Americans living with a serious or life-threatening illness. At least one hospital palliative care program is affiliated with 88% of private U.S. medical schools and 82% of state-funded schools. There are no postgraduate fellowship training programs, however, in 23 states and Washington, D.C.

The 2,651 physicians who have board certification in palliative medicine translate to 1 certified physician per 31,000 people living with a serious or life-threatening illness. In comparison, there are 16,800 cardiologists (or 1 per 71 patients with myocardial infarctions) and 10,000 oncologists (or 1 per 145 newly diagnosed cancer patients).

A new certification program in hospice and palliative medicine being offered by the American Board of Medical Specialties should help the field grow, Dr. Morrison said. But the “dramatic growth in the number of young physicians entering palliative care [is] … not quite enough to staff all these programs that are developing, so we also need to see midcareer people make a shift.”

Palliative care helps hospitals to improve patients' quality of life and satisfaction, and to match patients' goals to treatments, according to Dr. Morrison. Patients and families are demanding palliative care because it helps them to navigate care for life-threatening illness, one of the toughest times there is to get through the health care system, Dr. Morrison said.

Palliative care offers a coordinated approach to pain and symptom management, and addresses the patient's emotional, financial, and spiritual needs. Palliative care is usually delivered through a multidisciplinary team that might include physicians, nurses, social workers, pharmacists, psychiatrists, and a chaplain, priest, rabbi, or other religious representative.

The study was funded by seven nonprofit foundations and the United Hospital Fund, all of which support the CAPC and the NPCRC. The report is online at www.capc.org

Palliative care is offered in 41% of public hospitals and 29% of sole community provider hospitals, Dr. R. Sean Morrison said. ©Norman Y. Lono

Hospitals are rapidly adding palliative care services, but their availability is widely disparate, according to a report that gave a grade of “C” to the state of palliative care services in the nation's hospitals.

Overall, 53% of U.S. hospitals with 50 or more beds reported offering palliative care, according to the report card that was compiled by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC), which is based at Mt. Sinai School of Medicine in New York.

But geographic access varies widely, the report found. In three states—Alabama, Mississippi, and Oklahoma—10%–20% of hospitals offer palliative care. In Vermont, every hospital offers the service. The results were published online in the Journal of Palliative Medicine (2008 Oct. 2 [doi:10.1089/jpm.2008.0053]).

Hospitals were graded on patient access to palliative care services, patient access to board-certified palliative medicine specialists, medical student access to clinical training in palliative medicine, and physician access to specialty-level training in the field. The report is based on the American Hospital Association's 2006 Annual Survey Database and a more recent survey that was mailed to hospitals by the CAPC.

The report excluded rehabilitation, psychiatric, and pediatric hospitals. Children's hospitals were excluded because many pediatric palliative care programs are within general acute care facilities and there was no way to distinguish them, Dr. R. Sean Morrison, director of the NPCRC, said in an interview. Veterans Affairs hospitals also were excluded because the government requires every VA facility to offer palliative care, said Dr. Morrison, a coauthor of the report.

Hospitals with more than 300 beds were most likely to have palliative care, with 75% reporting a program. Nonprofit hospitals and hospitals affiliated with a medical school also were more likely to offer a palliative program.

Only 20% of for-profit hospitals report offering palliative care. Dr. Morrison said he was not sure why programs were few and far between at these facilities.

Palliative care is offered in 41% of public hospitals and 29% of sole community provider hospitals, creating a disparity of access for many urban, rural, and isolated areas, Dr. Morrison said.

The Midwest had the highest prevalence of hospitals with palliative care programs (65%), followed by the Northeast and the West. In the South, only 41% of hospitals offer palliative care.

There were some exceptions to the general trends. Montana, a largely rural state, had the second-highest prevalence, with 88% of hospitals offering palliative care. Dr. Morrison said that one of the pioneering palliative care programs was started in the state, which might explain why so many Montana hospitals have palliative care.

The report also pointed out a need for palliative care training to meet the needs of an estimated 90 million Americans living with a serious or life-threatening illness. At least one hospital palliative care program is affiliated with 88% of private U.S. medical schools and 82% of state-funded schools. There are no postgraduate fellowship training programs, however, in 23 states and Washington, D.C.

The 2,651 physicians who have board certification in palliative medicine translate to 1 certified physician per 31,000 people living with a serious or life-threatening illness. In comparison, there are 16,800 cardiologists (or 1 per 71 patients with myocardial infarctions) and 10,000 oncologists (or 1 per 145 newly diagnosed cancer patients).

A new certification program in hospice and palliative medicine being offered by the American Board of Medical Specialties should help the field grow, Dr. Morrison said. But the “dramatic growth in the number of young physicians entering palliative care [is] … not quite enough to staff all these programs that are developing, so we also need to see midcareer people make a shift.”

Palliative care helps hospitals to improve patients' quality of life and satisfaction, and to match patients' goals to treatments, according to Dr. Morrison. Patients and families are demanding palliative care because it helps them to navigate care for life-threatening illness, one of the toughest times there is to get through the health care system, Dr. Morrison said.

Palliative care offers a coordinated approach to pain and symptom management, and addresses the patient's emotional, financial, and spiritual needs. Palliative care is usually delivered through a multidisciplinary team that might include physicians, nurses, social workers, pharmacists, psychiatrists, and a chaplain, priest, rabbi, or other religious representative.

The study was funded by seven nonprofit foundations and the United Hospital Fund, all of which support the CAPC and the NPCRC. The report is online at www.capc.org

Palliative care is offered in 41% of public hospitals and 29% of sole community provider hospitals, Dr. R. Sean Morrison said. ©Norman Y. Lono

Hospitals are rapidly adding palliative care services, but their availability is widely disparate, according to a report that gave a grade of “C” to the state of palliative care services in the nation's hospitals.

Overall, 53% of U.S. hospitals with 50 or more beds reported offering palliative care, according to the report card that was compiled by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC), which is based at Mt. Sinai School of Medicine in New York.

But geographic access varies widely, the report found. In three states—Alabama, Mississippi, and Oklahoma—10%–20% of hospitals offer palliative care. In Vermont, every hospital offers the service. The results were published online in the Journal of Palliative Medicine (2008 Oct. 2 [doi:10.1089/jpm.2008.0053]).

Hospitals were graded on patient access to palliative care services, patient access to board-certified palliative medicine specialists, medical student access to clinical training in palliative medicine, and physician access to specialty-level training in the field. The report is based on the American Hospital Association's 2006 Annual Survey Database and a more recent survey that was mailed to hospitals by the CAPC.

The report excluded rehabilitation, psychiatric, and pediatric hospitals. Children's hospitals were excluded because many pediatric palliative care programs are within general acute care facilities and there was no way to distinguish them, Dr. R. Sean Morrison, director of the NPCRC, said in an interview. Veterans Affairs hospitals also were excluded because the government requires every VA facility to offer palliative care, said Dr. Morrison, a coauthor of the report.

Hospitals with more than 300 beds were most likely to have palliative care, with 75% reporting a program. Nonprofit hospitals and hospitals affiliated with a medical school also were more likely to offer a palliative program.

Only 20% of for-profit hospitals report offering palliative care. Dr. Morrison said he was not sure why programs were few and far between at these facilities.

Palliative care is offered in 41% of public hospitals and 29% of sole community provider hospitals, creating a disparity of access for many urban, rural, and isolated areas, Dr. Morrison said.

The Midwest had the highest prevalence of hospitals with palliative care programs (65%), followed by the Northeast and the West. In the South, only 41% of hospitals offer palliative care.

There were some exceptions to the general trends. Montana, a largely rural state, had the second-highest prevalence, with 88% of hospitals offering palliative care. Dr. Morrison said that one of the pioneering palliative care programs was started in the state, which might explain why so many Montana hospitals have palliative care.

The report also pointed out a need for palliative care training to meet the needs of an estimated 90 million Americans living with a serious or life-threatening illness. At least one hospital palliative care program is affiliated with 88% of private U.S. medical schools and 82% of state-funded schools. There are no postgraduate fellowship training programs, however, in 23 states and Washington, D.C.

The 2,651 physicians who have board certification in palliative medicine translate to 1 certified physician per 31,000 people living with a serious or life-threatening illness. In comparison, there are 16,800 cardiologists (or 1 per 71 patients with myocardial infarctions) and 10,000 oncologists (or 1 per 145 newly diagnosed cancer patients).

A new certification program in hospice and palliative medicine being offered by the American Board of Medical Specialties should help the field grow, Dr. Morrison said. But the “dramatic growth in the number of young physicians entering palliative care [is] … not quite enough to staff all these programs that are developing, so we also need to see midcareer people make a shift.”

Palliative care helps hospitals to improve patients' quality of life and satisfaction, and to match patients' goals to treatments, according to Dr. Morrison. Patients and families are demanding palliative care because it helps them to navigate care for life-threatening illness, one of the toughest times there is to get through the health care system, Dr. Morrison said.

Palliative care offers a coordinated approach to pain and symptom management, and addresses the patient's emotional, financial, and spiritual needs. Palliative care is usually delivered through a multidisciplinary team that might include physicians, nurses, social workers, pharmacists, psychiatrists, and a chaplain, priest, rabbi, or other religious representative.

The study was funded by seven nonprofit foundations and the United Hospital Fund, all of which support the CAPC and the NPCRC. The report is online at www.capc.org

Palliative care is offered in 41% of public hospitals and 29% of sole community provider hospitals, Dr. R. Sean Morrison said. ©Norman Y. Lono