Access to Palliative Care Remains Inadequate, Report Finds

Millions of Americans with serious illness, such as cancer, heart disease, kidney disease, and dementia, continue to have inadequate access to palliative care, according to the 2015 State-by-State Report Card from the Center to Advance Palliative Care. Findings were also published in Journal of Palliative Care.

The report, tracks growth of hospital palliative care programs and identifies areas where persistent gaps in access remain, found that one-third of US hospitals with at least 50 beds report they have no palliative care services.

“The rate of growth of current health care expenditures is unsustainable and is perhaps the single greatest threat to the American way of life,” the authors wrote. “Our sickest and most complex patients are the ones who fall through the cracks in the system.”

The overall grade for the United States was a B, which was unchanged from 2011. The number of states that received an A, for having more than 80% of the state’s hospitals reporting a palliative care team, increased from 2011, and for the first time no state received an F grade for having less than 20% of state hospitals reporting a palliative care team.

Large hospitals are more likely to report they provide palliative care (90% with 300 or more beds) while for-profit hospitals report lower rates of palliative care services (54% of for-profit hospitals with 300 beds or more). Region of the country is also a big determinant. West South Central (Arkansas, Louisiana, Oklahoma, and Texas) and East South Central (Alabama, Kentucky, Mississippi, and Tennessee) both received overall C grades, while New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) received an A for the region.

The good news is that a large majority (96%) of teaching hospitals have palliative care teams, which increases the likelihood that the next generation of clinicians will receive training in this area.

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