Despite the myriad benefits of palliative care, as well as its recent growth, more progress is needed. Availability varies considerably by region and by state. The 2011 State-by-State Report Card updates the 2008 Report Card.
The study, America′s Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation′s Hospitals, conducted by the Center to Advance Palliative Care (CAPC) and National Palliative Care Research Center (NPCRC), examines variation in access to palliative care at the state level in order to help both the public and policymakers increase the availability of these services for all Americans in need.
As we have seen in other areas of our health care system, we found wide geographic variation in access to palliative care services. Factors predicting the presence of a hospital palliative care team have not changed markedly since the 2008 Report Card.
As the Dartmouth Atlas researchers have often pointed out, “geography is destiny.” The same holds true when speaking of access to hospitals offering palliative care. If you′re living in the South, for example, you′re much less likely to find a hospital with a palliative care program. If you′re living in a region where there are only small hospitals (fewer than fifty beds), for example, your chances of having access to palliative care are extremely limited.
In 2008, our nation received an overall grade of C. In 2011, the country receives an overall grade of B. Seven states plus the District of Columbia now receive a grade of A, with more than 80 percent of hospitals reporting palliative care services. More than half of the fifty states receive a grade of B. Fewer than 25 percent of states now need significant improvement (C). Approximately 12 percent receive nonpassing grades of D or F.
District of Columbia (100%); Maryland (90%); Minnesota (89%); Nebraska (93%); Oregon (88%) Rhode Island (88%); Vermont (100%); Washington (83%)
Arizona (69%); California (67%); Colorado (73%); Connecticut (72%); Florida (62%); Idaho (63%); Illinois (67%); Indiana (63%); Iowa (61%); Maine (71%); Massachusetts (67%); Michigan (76%); Missouri (75%); Montana (67%); Nevada (69%); New Hampshire (77%); New Jersey (80%); New York (75%); North Carolina (75%); North Dakota (67%); Ohio (80%); Pennsylvania (67%); South Dakota (78%); Virginia (78%); Wisconsin (74%)
Georgia (43%); Hawaii (58%) ; Kansas (47%); Kentucky (55%); Louisiana (43%); New Mexico (44%) South Carolina (51%); Tennessee (52%); Texas (42%); Utah (60%); West Virginia (55%); Wyoming (50%)
Alabama (28%); Alaska (29%); Arkansas (38%); Oklahoma (30%)
Delaware (20%); Mississippi (20%)
In 2008, the eleven states with the lowest prevalence rates were: Mississippi (10 percent), Alabama (16 percent), and Oklahoma (19 percent), Nevada (23 percent), Wyoming (25 percent), Louisiana (27 percent), South Carolina (30 percent), Texas (33 percent), New Mexico (33 percent), Kentucky (37 percent) and Georgia (38 percent). Today, only Delaware and Mississippi get an F (20 percent). However, Mississippi demonstrated substantial improvement since 2008, doubling its prevalence from 10 to 20 percent.
The prevalence of hospital palliative care in Alabama increased from 16 to 28 percent. Oklahoma increased from 19 to 30 percent. Seven states improved their grades from a D to a C: Georgia, Kentucky, New Mexico, Texas, South Carolina, Louisiana and Wyoming. Nevada saw dramatic gains, rising from a D to a B grade.
States getting an A nearly tripled from three in the 2008 Report Card to seven plus the District of Columbia in 2011.
The 2011 Report Card shows that the national prevalence rate for palliative care services in small hospitals is 22 percent.
In addition to marked disparities in geographic availability, we observed low rates of access to palliative care in public and sole community provider hospitals. Public and sole community provider hospitals often serve as the only option for medical care for the forty-seven million Americans lacking health care coverage or living in geographically isolated communities:
A major barrier facing the expansion of palliative care services is the lack of palliative medicine physicians. Where there is approximately one cardiologist for every 71 persons experiencing a heart attack and one oncologist for every 141 newly diagnosed cancer patients, there is only one palliative medicine physician for every 1,200 persons living with a serious or life-threatening illness.
Improving access to palliative care for America’s patients and families requires a workforce highly trained in the fundamentals of palliative medicine. Today in the United States there are 2,887 physicians board-certified in palliative medicine. Prevalence of board-certified palliative care physicians varies across states:
Although access to palliative care in the hospital setting is improving year-by-year, people living with a serious illness will still find significant disparities in their access to a hospital that provides palliative care. Focused efforts by hospital administration, the health care community, and policymakers are required to promote the development of quality palliative care programs in all hospitals, with special attention needed in small, rural, public and for-profit hospitals (see Recommendations for Action section of this report). This will result in a more efficient and effective use of hospital resources, and will enhance the quality of care delivered to our nation′s most seriously ill patients and their families.
 The Dartmouth Institute for Health Policy and Clinical Practice. The Dartmouth Atlas of Health Care website, www.dartmouthatlas.org. Accessed January 13, 2011.