The country’s palliative care services are improving, but millions of seriously ill Americans still do not have access to these types of end-of-life services, according to new findings released Oct. 6.
The study, America′s Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation′s Hospitals, conducted by the Center to Advance Palliative Care and National Palliative Care Research Center, examines variations in access to palliative care at the state level. The study, referred to as a “report card,” ranks states by the quality of their palliative care services and looks at whether states have improved since 2008, when the survey was first conducted.
The report card shows considerable improvement in the growth of palliative care. Out of a total of 2,489 hospitals nationwide who participated in the survey, about 1,500 reported that they provide palliative care services.
A relatively new medical subspecialty, palliative medicine seeks to improve the quality of life for people facing serious and chronic illness. It is specialized care, and focuses on providing patients with relief from the symptoms, pain and stresses of a serious illness – whatever the diagnosis. With approximately 90 million Americans living with serious and chronic illnesses, such as cancer, heart disease, diabetes, Parkinson's, stroke and Alzheimer's, the need for palliative care is growing.
This year, the report gives seven states plus the District of Columbia an “A” rating. The best-rated states include Maryland, Minnesota, Nebraska, Oregon, Rhode Island, Vermont and Washington. That’s up from 2008, when only three states – Vermont, Montana and New Hampshire – received an “A” rating.
More than half of the fifty states received “B” grade. Seven states improved from a “D” to a “C” from 2008 to 2011 including Georgia, Kentucky, New Mexico, Texas, South Carolina, Louisiana and Wyoming.
Nevada saw dramatic gains, rising from a “D” to a “B” grade. In 2011, only two states – Delaware and Mississippi – received a failing grade for their access to palliative care services. Oklahoma, Alabama and Arkansas improved from an “F” in the 2008 report card to a “D” in 2011.
As in other areas of the U.S. healthcare system, the study found wide geographic variation in access to palliative care services. In the South, for example, hospitals are less likely to have a palliative care program. In regions, especially rural areas, where there are only small hospitals – those with fewer than fifty beds – for example, palliative care services are also less common.
Unsurprisingly, 85 percent of large hospitals with 300 or more beds reported that that had a palliative care team. In small hospitals, the national prevalence rate for palliative care services is only 22 percent.
The highest prevalence rates for palliative care services in small hospitals are found in New Hampshire – 62 percent – and Maine – 58 percent. The lowest prevalence rates in small hospitals are found in the South. Small hospitals in Louisiana and Mississippi had no palliative care services and prevalence in Alabama was 4 percent.
In addition to marked disparities in geographic availability, the report shows low rates of access to palliative care in public and sole community provider hospitals. Public and sole community provider hospitals often serve as the only option for medical care for uninsured Americans or those that live in geographically isolated communities. For public hospitals, 54 percent reported having a palliative care teams while 37 percent of sole community provider hospitals had these services. Meanwhile, only 26 percent of for-profit hospitals have a palliative care team.
A major barrier for patients accessing palliative care is the lack of palliative medicine physicians. Where there is approximately one cardiologist for every 71 persons experiencing a heart attack and one oncologist for every 141 newly diagnosed cancer patients, there is only one palliative medicine physician for every 1,200 persons living with a serious or life-threatening illness.
The highest physician-to-patient ratings are to be found in Hawaii, which has one physician per 154 Medicare deaths; New Mexico, with one per 222 Medicare deaths; and Colorado, with one per 244 Medicare deaths. The lowest rates are in Mississippi, which has one physician per 1,698 Medicare deaths; Rhode Island, with one per 1,267 Medicare deaths; and Montana, with one per 1,218 Medicare deaths.
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