Access to Palliative Care Remains an Issue in US Hospitals

A study reports that despite the steady growth in hospital-based palliative care programs, access is sketchy and is driven by geographic location and hospital ownership.

A report from Mount Sinai provides the current status of patient access to palliative care in hospitals across the country. And the findings are a mixed bag.

For the study, published in the Journal of Palliative Medicine, the authors collected data from and exhaustive list of sources: survey by the American Hospital Association for years 2012 and 2013, the National Palliative Care Registry, the Dartmouth Atlas of Healthcare, the American Census Bureau's American Community Survey (ACS), web searches, and telephone interviews of hospital administrators and program directors.

The results discovered that 67% of hospitals with 50 or more facility beds had an institutional palliative care program. The presence of a palliative care program was determined by the size of the hospital—90% of hospitals with 300 or more beds had a palliative care program, compared with only 56% with fewer than 300 beds. For-profit hospitals, the study found, were less likely to have the service though. Not-for-profit hospitals and public hospitals were, respectively, 4.8 times and 7.1 times more likely to have a palliative care program as compared to for-profit hospitals. A geographic analysis found a higher density of these programs in the New England (88%), Pacific (77%), and mid-Atlantic (77%) hospitals, compared with hospitals in the south central (43%) and east south central (42%) of the nation.

The authors conclude that while there’s been a steady growth in hospital-based palliative care programs, with participation seen from large hospitals and academic centers, access is sketchy and is driven by geographic location and hospital ownership.

According to Charles F. von Gunten, MD, PhD, editor in chief of the Journal of Palliative Medicine, “This report holds both good news and bad. The good news is the inexorable improvement in access to palliative care. The bad news is that this scientifically proven best care is not available to all people in all hospitals."