By INDU SPUGNARDI
Palliative care is one of the fastest-growing services in health care, according to a new report released by the Center to Advance Palliative Care and the National Palliative Care Research Center. The report, "America's Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation's Hospitals," finds that the number of hospital-based palliative care programs has increased by 138 percent since 2000. Despite this growth, however, the report also finds that millions of Americans with serious and life-threatening illnesses do not have access to palliative care.
The report, available at www.capc.org, updates a 2008 publication of the same name. It finds that geography and hospital size and type are key predictors of access to palliative care.
- Geography: In the Northeast, 73 percent of hospitals with 50 or more beds report having a palliative care team, compared to only 51 percent in the South.
- Hospital size: Nationally, the prevalence of palliative care in large hospitals with 300 or more beds is 85 percent, ranging from 50 percent in Alabama and Delaware, to 100 percent in 19 states. Among hospitals with fewer than 50 beds, access to palliative care is more limited, ranging from 14 percent in the South to 45 percent in the Northeast.
- Hospital type: Nationally, the prevalence of palliative care in hospitals with 50 or more beds is 63 percent. The prevalence in for-profit, public and sole community provider hospitals is lower — 26 percent, 54 percent and 37 percent, respectively.
The report offers policy recommendations to promote widespread access to palliative care in all settings. The recommendations include increasing the number of palliative care specialists; establishing a strong science base for palliative care to improve quality; and requiring the provision of palliative care in hospitals, nursing homes, and community settings through changes in measurement, payment and accreditation standards.
Growth drivers
Dr. Diane E. Meier, a coauthor of the report and director of the Center to Advance Palliative Care, identifies two main reasons behind the rapid growth of palliative care programs in hospitals — a need to improve the quality of care for seriously ill patients and a need to deliver that care more cost effectively. "People realize the days of high-volume, high-cost health care are over, and they are looking for better ways to care for patients at a lower cost," said Meier. "There is a strong and growing evidence base that palliative care improves the quality of life of seriously ill patients at lower costs."
The current health care delivery system, which provides incentives for high-cost procedures and specialty care rather than in-depth communication and care coordination, often does not meet the complex needs of seriously ill patients. Research finds the main quality problems are lack of communication with physicians, fragmented care, untreated pain, inappropriate use of intensive care units and other high-technology medicine, and severe financial and psychological stress on family members.
As private and public payers and patient advocates call for improved quality, hospitals also are facing intense pressure to deliver care more efficiently. Meier points out that palliative care, which focuses on symptom management and care coordination, helps reduce emergency room visits, repeat hospitalizations and lengths of stay for seriously ill patients. Through the use of carefully crafted care plans and expert communication, palliative care also can help reduce the use of high-cost medicine such as the ICU and expensive diagnostic procedures. Terminally ill patients who are fully informed about their prognosis and treatment options often, but not always, opt for less aggressive treatments in lower-cost settings, which fit with their wishes. Recent research suggests palliative care also can prolong life. The results of a study published in the Aug.19, 2010,New England Journal of Medicine found that early palliative care intervention for patients with lung cancer resulted in an improved quality of life, less aggressive interventions and longer survival than those receiving standard care.
Moving forward
While advocates of palliative care are pleased with the growing number of hospital-based palliative care programs, they realize that hospital access is not the only issue. Ensuring that the programs are of high quality and that palliative care is accessible in all settings are also important goals. The National Quality Forum has proposed measures for assessing the quality of palliative care. The measures are open for public comment on the forum's website .
Advocates are hopeful that reform-driven changes in payment policies and health care delivery models, such as accountable care organizations and bundled payments, will create the business case to provide palliative care in other settings of care — such as nursing homes and community-based settings. "The evidence that palliative care provides high-quality care at lower costs is growing," said Meier. "As organizations figure out how to deliver care in this new health care environment, palliative care has to be part of the solution."
Copyright © 2011 by the Catholic Health Association
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