Executive Summary

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 specialized care for people with serious illnesses. It is focused on providing patients with relief from the symptoms, pain, and stresses of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses, and other specialists who work together with a patient's other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.

Ten years ago there were almost no palliative care programs in America′s hospitals. Today, 63 percent of hospitals with fifty or more beds provide a palliative care team. In the last five years alone, access to palliative care in our nation′s hospitals has more than doubled.

While palliative care teams are being implemented at a rapid pace in U.S. hospitals, wide geographic variation remain a barrier to equal access. The Center to Advance Palliative Care (CAPC) 2011 “report card” shows that the nation gets an overall grade of B in access to hospital palliative care —an improvement since 2008 when the nation received an overall grade of C. 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 non-passing grades of D or F.

This Center to Advance Palliative Care (CAPC) and National Palliative Care Research Center (NPCRC) report card 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 and district levels in order to assess whether seriously ill patients throughout the United States are receiving equitable care. Specifically, the report examines:

Patient access to palliative care services in hospitals
Patient access to board-certified palliative care professionals (e.g., physicians and nurses)

Hospitals with fifty or more beds are the primary focus of the report card since smaller hospitals 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 Database™ for fiscal year 2009.

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.