The Growth of Palliative Care in U.S. Hospitals: A Status Report

Abstract

Background: Palliative care is expanding rapidly in the United States.

Objective: To examine variation in access to hospital palliative care.

Methods: Data were obtained from the American Hospital Association (AHA) Annual Surveys™ for Fiscal 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. Multivariable logistic regression was used to examine predictors of hospital palliative care programs.

Results: Sixty-seven percent of hospitals with 50 or more total facility beds reported a palliative care program. Institutional characteristics were strongly associated with the presence of a hospital palliative care program. Ninety percent of hospitals with 300 beds or more were found to have palliative care programs as compared to 56% of hospitals with fewer than 300 beds. Tax status was also a significant predictor. 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. Palliative care penetration was highest in the New England (88% of hospitals), Pacific (77% of hospitals), and mid-Atlantic (77% of hospitals) states and lowest in the west south central (43% of hospitals) and east south central (42% of hospitals) states.

Conclusions: This study demonstrates continued steady growth in the number of hospital palliative care programs in the United States, with almost universal access to services in large U.S. hospitals and academic medical centers. Nevertheless access to palliative care remains uneven and depends on accidents of geography and hospital ownership.

FIG. 1.

Regional and national growth of palliative care programs in U.S. hospitals with 50 or more beds. The dates in the figure correspond to the fiscal year from which the data were obtained. Data from fiscal year 1998 represent unpublished data from the 2001 report. Data from fiscal year 2003 were published in the 2005 report, data from fiscal year 2006 were published in the 2008 report, and data from fiscal year 2009 were published in the 2011 report. Due to changes in our methodology, the 2015 report reflects 2014 calendar year data. Color image is available online at www.liebertpub.com/jpm

FIG. 2.

Prevalence and distribution of palliative care programs in U.S hospitals with 50 or more beds. States were assigned a letter grade based on the percentage of hospitals with palliative care programs. A grades were assigned to states in which over 80% of hospitals had palliative care programs, B grades to states with 61%–80% of hospitals with palliative care programs, C grades to states with 41%–60% of hospitals having palliative care programs, and D grades to states with 21%–40% of hospitals having palliative care programs. Color image is available online at www.liebertpub.com/jpm