Center to Advance Palliative Care Releases Best and Worst States Providing Access to Palliative Care

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2015 State-by-State Report Card shows improvement, but persistent gaps in access for the seriously ill remain

America’s Care of Serious Illness: 2015 State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals, released today on Capitol Hill and in the Journal of Palliative Medicine, demonstrates that access to palliative care remains highly variable and depends more upon accidents of geography and hospital ownership than it does upon the needs of patients with serious illness and their families.

Millions of seriously ill Americans and their families living in the south of the United States, as well as in Alaska, Kansas, New Mexico, and Wyoming, still have inadequate access to palliative care teams. The report was conducted by the Center to Advance Palliative Care (CAPC) and National Palliative Care Research Center (NPCRC).

Palliative care is a new medical specialty focused on maximizing quality of life during serious illness through relief of the pain, symptoms and stress that patients and their families commonly experience. It is delivered at the same time as all other appropriate treatments. Palliative care leads to better quality of care, longer life, and is appropriate at any age and any stage of a serious illness.

Key findings on the growth in access to hospital palliative care teams across the fifty states include:

  • Overall, the southern U.S states received a grade of C (60% or fewer hospitals have palliative care teams) as compared to As and Bs (60% or more hospitals) for all other regions.
  • States receiving a D grade (40% or less of hospitals having palliative care) were Alabama, Alaska, Arkansas, Mississippi, New Mexico, Oklahoma and Wyoming.
  • Only 23% of for-profit hospitals have palliative care. Not-for-profit hospitals are 7 times more likely to have a palliative care team than for-profits.
  • In a sign of progress since 2008, 17 states received a grade of A (up from 3 in the 2008 report and 7 in the 2011 report). They are: Connecticut, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Jersey, Ohio, Oregon, Rhode Island, South Dakota, Utah, Vermont, Washington and Wisconsin.
  • 90% hospitals with 300 beds or more have palliative care teams.
  • 90% of hospitals operated by the Catholic Church have palliative care.
  • 78% of Medicare patients died near a hospital that had a palliative care team, suggesting that access is improving for this patient population.
  • 96% of teaching hospitals now have palliative care teams, increasing the likelihood that the next generation of clinicians will receive training.

“It is our hope that this report card focuses attention on lingering gaps in access to palliative care in our nation’s hospitals,” said Diane E. Meier, MD, director of the Center to Advance Palliative Care. “Palliative care, like any core medical service such as ICU’s or emergency departments, should be available in all U.S. hospitals.”

R. Sean Morrison, MD, director of the National Palliative Care Research Center added, “The dramatic growth in the number of hospitals with palliative care teams is encouraging. Whereas we need to continue to assist hospitals in C and D states in developing palliative care teams, it is important to focus attention on ensuring that all seriously ill who would benefit from palliative care actually receive it in a timely fashion, and that access moves beyond hospitals to other sites of care.”

Barriers to palliative care access remain in three key areas: a workforce that is too small to meet current and projected demand; an underdeveloped knowledge base to provide the highest quality of care, and a lack of payment models linked to quality measures. Widely supported legislation pending in Congress would facilitate research, professional development and public education in palliative care.

The research team for this report was led by R. Sean Morrison, MD, director of the National Palliative Care Research Center and Diane E. Meier, MD, director of the Center to Advance Palliative Care.

Center to Advance Palliative Care
The Center to Advance Palliative Care (CAPC) is a national organization dedicated to increasing the availability of quality palliative care services for people facing serious illness. CAPC provides health care professionals with tools, training, technical assistance and metrics necessary to successfully implement and sustain palliative care programs in hospitals and other health care settings. Led by Diane E. Meier, MD, CAPC is part of the Icahn School of Medicine at Mount Sinai in New York City. http://www.capc.org reportcard.capc.org

The National Palliative Care Research Center
The National Palliative Care Research Center (NPCRC) is dedicated to advancing palliative care research capacity in the United States. It works to rapidly translate important research findings into clinical practice in order to improve the care received by patients living with serious illness and their families Led by R. Sean Morrison, MD, the NPCRC is part of the Icahn School of Medicine at Mount Sinai, located in New York City. http://www.npcrc.org

The report card was supported in part by grants from the American Cancer Society, the Cambia Health Foundation and the National Institute on Aging of the National Institutes of Health.

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Lauren Rankin
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