Palliative care programs are being implemented at a rapid pace in U.S. hospitals, but wide geographic variation remains a barrier to equal access for patients and families. The Center to Advance Palliative Care (CAPC) 2008 “report card” shows that the nation gets an overall grade of C in access to hospital palliative care. Although half of the fifty states receive a grade of A or B, almost 40 percent get a grade of C, and more than 20 percent receive unacceptable grades of D and F. Only three states earn a grade of A.
Approximately ninety million Americans are living with serious and life-threatening illness, and this number is expected to more than double over the next twenty–five years with the aging of the baby boomers. Yet, studies show that most people living with a serious illness experience inadequately treated symptoms; fragmented care; poor communication with their doctors; and enormous strains on their family caregivers.
Palliative care was developed in response to these inadequacies. A relatively new medical subspecialty, palliative medicine is focused on improving quality of life—and quality of care—for seriously ill patients and families. Palliative care provides comprehensive symptom management, intensive communication and coordination of care that addresses the episodic and long-term nature of serious, chronic illness. Patients therefore benefit from well-controlled symptoms, improved patient-physician-family communication and satisfaction with their care. Delivered by a palliative care team, hospital palliative care programs enhance the efficiency and effectiveness of hospital services.
Unlike those who need hospice, patients in need of hospital palliative care do not need to be terminally ill. Hospital palliative care is appropriate at any time during a person′s illness—from the time of diagnosis and at the same time as curative or other life-prolonging treatments.
Ten years ago there were almost no palliative care programs in America′s hospitals. Today, 53 percent of hospitals with fifty or more beds have a program. In the last five years alone, access to palliative care in our nation′s hospitals has more than doubled. Rapid growth is largely due to the increasing numbers and needs of Americans living with serious and chronic illnesses and the realities of the responsibilities carried by their families.
This Center to Advance Palliative Care (CAPC) and National Palliative Care Research Center (NPCRC) report was undertaken in an effort to add to the literature on health care quality for seriously ill patients. It examines geographic variations at the state level in order to assess whether seriously ill patients throughout the United States are receiving equitable care. Specifically, we examine:
- Patient access to palliative care services in hospitals
- Patient access to board-certified palliative medicine physicians
- Medical student access to clinical training in palliative medicine
- Physician access to specialty-level training in palliative medicine
Hospitals with fifty or more beds are the primary focus of the report card because hospitals smaller than this are unlikely to be able to support a full interdisciplinary palliative care team. Hospital data were obtained from the American Hospital Association (AHA) Annual Survey DatabaseTM for fiscal year 2006, supplemented by mailed surveys.
This national and state-by-state report presents the most accurate estimates to date of the prevalence of hospital palliative care programs in the United States.
