Methodology

A. Methodology for Analysis of State Grades

Data Sources

Data for the 2011 State Report Card were obtained from four primary sources: the American Hospital Association’s (AHA) Annual Survey of Hospitals Database™ for Fiscal Year 2009 (for hospital data), the American Board of Medical Specialties (ABMS) (for data on physicians’ board certified in hospice and palliative medicine), National Board for Certification of Hospice and Palliative Nurses (NBCHPN) (for data on advanced practice nurses and registered nurses board certified in hospice and palliative nursing), and the Dartmouth Atlas of Health Care (for Medicare data). Supplemental hospital data was obtained from the National Palliative Care Registry™, which provides operational data on the features and processes of care for hospital palliative care programs.

Hospital Data: Data on hospital characteristics were obtained from the AHA Annual Survey of Hospitals Database™ for Fiscal Year 2009. Since 1946, the AHA has surveyed all member and nonmember hospitals in the United States and its associated areas on an annual basis. The survey is the most comprehensive data source for hospital information including over 850 elements on hospitals’ services, utilization, staffing, financial, and total facility beds. It has an annual response rate of approximately 85%.

The survey also queries hospitals as to the presence of a palliative care program. The survey defines palliative care program as “an organized program providing specialized medical care, drugs or therapies for the management of acute or chronic pain and/or the control of symptoms administered by specially trained physicians and other clinicians; and supportive care services, such as counseling on advanced directives, spiritual care, and social services, to patients with advanced disease and their families.” The survey asks hospitals to report a palliative care program based on the manner in which the service is provided:

By the hospital;
By the Health System;
By the Health Care Network; or
Through a contractual arrangement or joint venture with another provider (e.g., a hospice providing nonhospice palliative care to hospital patients).

For this report, any hospital reporting a palliative care program in any of the four afore-mentioned categories was coded as having an active program.

Primary data from AHA was supplemented by data from the National Palliative Care Registry™. The Registry, developed jointly by the Center to Advanced Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC), is the only repository for national data on the structure and processes of hospital palliative care programs. The Registry, launched in 2009, was created to help develop operational standards and demonstrate the reach and impact of the palliative care field.

Hospitals reporting a program to the National Palliative Care Registry™ as of March 17, 2011 were included in our analyses for this report regardless of their response to the AHA Annual Survey of Hospitals.

Hospice and Palliative Medicine/Nursing Board Certification Data: Data concerning the board-certification status of physicians abstracted from the American Board of Medical Specialties (ABMS), American Board of American Board of Hospice and Palliative Medicine (ABHPM) databases. The information on board certified physicians includes results from the 2008 ABMS certification examination (at the time of the data analysis results from the 2010 ABMS certification examination were not available). Statistics are derived from the Official ABMS Directory Database of board certified medical specialists provided by Elsevier, and the ABHPM Directory Database of board certified diplomats provided by the American Academy of Hospice and Palliative Medicine. Please note that the data on physicians certified in hospice and palliative medicine does not include HPM osteopathic physicians certified by the American Osteopathic Association.

Data on the board certification status of advance practice nurses and registered nurses were taken from the National Board for Certification of Hospice and Palliative Nurses (NBCHPN®) databases (accessed on March 17, 2011).

Medicare Data: Data on Medicare enrollee deaths and Medicare deaths occurring in hospitals were obtained from the Dartmouth Atlas of Healthcare at www.darthmouthatlas.org.

Hospital Population (Inclusion and Exclusion Criteria)

Hospitals were included in this study if they admitted adult patients and the majority of admissions were identified as a) general medical-surgical, b) obstetrics/gynecology, c) cancer, or d) cardiac.

Hospitals were excluded if they are:

Rehabilitation, psychiatric, or eye, ear, nose and throat hospitals, and subacute and chronic care facilities;
Pediatric hospitals;
Fall under federal control (e.g., U.S. Department of Veterans Affairs);
Located outside of the 50 states and the District of Columbia; or
Did not respond to the AHA survey*.

*Note: Hospitals reporting a palliative care program to the National Palliative Care Registry™ were included even if they did not respond to the AHA survey.

B. Methodology for Analysis of Congressional Districts

Data on U.S. hospitals with palliative care was obtained from the American Hospital Association’s (AHA) Annual Survey of Hospitals Database™ for Fiscal Year 2009 and supplemented with data from the National Palliative Care Registry™, which provides operational data on the features and processes of care for hospital palliative care programs.

Data on U.S. congressional district boundaries were obtained from ESRI. The congressional districts used in this analysis represent the current 112th Congress, which convened on January 3, 2011 and will end on January 3, 2013.

Hospital addresses were geocoded using ArcGIS 9.3 from ESRI. Geocoding is a process that assigns geographic coordinates to a list of addresses. The hospital geographic coordinates were then joined to the 112th U.S. Congressional District boundary file in order to determine which congressional district a hospital is located.

Disclaimer

Not all hospital addresses were matched to a geographic coordinate using the geocoding process. As a result, the nearest address to an unmatched hospital address was used to determine the congressional district boundary.