Access to palliative care uneven among states

WASHINGTON - Although most large hospitals around the country offer seriously ill patients the support of special teams to manage pain and complex symptoms, a report card issued Wednesday shows few states making top grades with palliative care.

Palliative care is among the nation's fastest-growing specialties, intended to focus on patient comfort and quality of life. But unlike hospice care, it does not necessarily anticipate that a patient is nearing the end of life.

Some 90 million Americans living with serious and chronic illnesses, from cancer and heart disease to diabetes and Alzheimer's, could potentially benefit from palliative care.

"As with many services in health care, where you live often determines what level of care you receive, and that trend certainly holds true for palliative care,'' said Dr. Sean Morrison, director of the National Palliative Care Research Center and lead author of the report.
Based on surveys of nearly 2,500 hospitals, the study found that nearly two-thirds of those with more than 50 beds offer a palliative care program, but the services are offered in only about 20 percent of hospitals with fewer than 50 beds.

The nation as a whole received a "B" grade for palliative care, as did most states. Only seven states -- Maryland, Minnesota, Nebraska, Oregon, Rhode Island, Vermont and Washington, plus the District of Columbia -- got an "A." Just two states, Delaware and Mississippi, received an "F" rating.

Morrison said other research suggests that in states with more hospital-based palliative care, patients are less likely to die in the hospital, spend fewer days in intensive care, have better pain management and high satisfaction with their care.

Palliative teams first sprang up in teaching hospitals and have spread to more facilities, but still are more likely to be found in nonprofit hospitals.

"One of the things we're still working to show is that these teams not only improve quality, but can also save money by reducing excessive care and reducing the number of re-admissions, ‘' Morrison said.

While there are relatively few patients in small and rural hospitals who could benefit from palliative care any particular day, "there are models that can make it work, say with a nurse-practitioner specially trained in palliative care and backed up by a physician, social workers, chaplains and others in that hospital with some basic instruction,'' Morrison said.

One major problem lies in getting enough doctors and nurses trained in the specialty, which has not been accounted for in the allocation of training spots subsidized by the federal government.

"When we're wrestling with escalating Medicare costs and a growing elderly population, these teams can provide a solution to that part of the health care crisis created when 10 percent of patients drive 60 percent of the costs,'' Morrison said.

To review the report online, go to www.capc.org/reportcard

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