Hospital-based palliative care rises 19%

More states are providing access to the care, but a shortage of trained specialists has slowed growth.

By Kevin B. O’Reilly — Posted Oct. 17, 2011

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The nation has improved its overall grade on providing hospital-based palliative care to a B, up from a C in 2008.

The higher grade is due to a 19% rise in the number of hospitals with palliative care teams since 2008, according to a report released in October. The number of 50-plus bed hospitals with palliative care teams has nearly tripled since 2000 to 63%, said the research conducted by the Center to Advance Palliative Care, a New York nonprofit that helps hospitals set up palliative care operations. Eighty-five percent of hospitals with 300 beds or more have such teams in place, the report said.

Palliative care teams are composed of physicians, nurses, social workers and chaplains who help patients with serious or life-threatening illnesses by treating pain and other symptoms, finding the best setting for the patient after discharge, and alleviating psychosocial and family burdens.

"The Joint Commission doesn't require palliative care teams for accreditation, yet nonetheless we've seen an exponential growth in a very short period of time," said Diane E. Meier, MD, director of the Center to Advance Palliative Care and co-author of the study.

"This reflects the responsiveness of palliative care teams to the obvious need on the ground.

"This is starting to become the standard of care throughout the country," said Dr. Meier, director of the Hertzberg Palliative Care Institute and professor of geriatrics and internal medicine at Mount Sinai School of Medicine in New York. "There is an accumulating body of evidence that not only does palliative care improve quality of life and quality of care but also significantly reduces hospital spending."

For example, patients with lung cancer who received palliative care along with conventional treatment survived 2.7 months longer than patients who received only standard oncologic care, according to a study of 151 patients in the Aug. 19, 2010, New England Journal of Medicine.

Progress varies

The growth of palliative care teams has been uneven. Thirty-two states and the District of Columbia earned an A or B for having palliative care in place at 60% or more of 50-plus bed hospitals. That is up from 24 states in the 2008 report card. Six states received a D or an F for failing to make palliative care available at more than 40% of their hospitals.

The availability of palliative care services also is limited by a shortage of physicians and other health professionals trained to provide the specialized care, experts said.

Nationally, there are about 3,000 physicians who have received board certification in palliative care, said R. Sean Morrison, MD, lead author of the report and director of the National Palliative Care Research Center in New York. That figure is expected to rise by about 1,200 when the next board-certification exams are held in 2012.

There is one oncologist for every 141 newly diagnosed cancer patients, compared with one palliative medicine doctor for every 1,200 patients with serious or life-threatening illnesses, the report said. There are 73 accredited palliative care fellowship programs in the U.S. producing about 90 new palliative medicine physicians annually.

The report calls for lifting the cap on Medicare-funded residency positions and redistributing some unused slots to accredited palliative medicine fellowship training.

Despite broader availability of palliative care teams in hospitals, too often the patients' primary physicians wait too long before involving palliative specialists, said Dr. Morrison, professor of palliative care at Mount Sinai School of Medicine.

"Does my patient have three or more distressing symptoms that are interfering with quality of life? Have they been in the hospital multiple times recently? Is the family distressed?" Dr. Morrison asked. "If the answers are yes, then they could benefit from palliative care. Palliative care is not just for the end of life, but throughout a serious or life-threatening illness."

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Making the grade on palliative care

View in PDF

Click to see data in PDF.

Among hospitals with 50 or more beds, 63% now have palliative care programs, compared with 53% in 2008. Overall, the nation received a B on giving patients with serious illnesses access to hospital-based palliative care.

Here is how the grading breaks down by state.

"A" programs in 83% to 100% of hospitals -- 7 states and D.C.: District of Columbia (100%), Vermont (100%), Nebraska (93%), Maryland (90%), Minnesota (89%), Oregon (88%), Rhode Island (88%) and Washington (83%)

"B" programs in 61% to 80% of hospitals -- 25 states: New Jersey (80%), Ohio (80%), South Dakota (78%), Virginia (78%), New Hampshire (77%), Michigan (76%), New York (75%), North Carolina (75%), Missouri (75%), Wisconsin (74%), Colorado (73%), Connecticut (72%), Maine (71%), Arizona (69%), Nevada (69%), California (67%), Illinois (67%), Massachusetts (67%), Montana (67%), North Dakota (67%), Pennsylvania (67%), Idaho (63%), Indiana (63%), Florida (62%) and Iowa (61%)

"C" programs in 42% to 60% of hospitals -- 12 states: Utah (60%), Hawaii (58%), Kentucky (55%), West Virginia (55%), Tennessee (52%), South Carolina (51%), Wyoming (50%), Kansas (47%), New Mexico (44%), Georgia (43%), Louisiana (43%) and Texas (42%)

"D" programs in 28% to 38% of hospitals -- 4 states: Arkansas (38%), Oklahoma (30%), Alaska (29%) and Alabama (28%)

"F" programs in 0% to 20% of hospitals -- 2 states: Delaware (20%) and Mississippi (20%)

Source: "America's Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation's Hospitals," Center to Advance Palliative Care, October (link)

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External links

"America's Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation's Hospitals," Center to Advance Palliative Care, October (link)

"Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer," The New England Journal of Medicine, Aug. 19, 2010 (link)

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