The number of hospital palliative care teams has soared over the past decade, including a 138% increase at institutions with more than 50 beds, according to the Center to Advance Palliative Care (CAPC).
The center looked at data from the American Hospital Association’s Annual Survey and the National Palliative Care Registry from 2000 to 2009. Of the 2,489 hospitals studied, 1,568 (63%) reported having a palliative care team.
Dr. Allen S. Lichter
Uptake was greater at large hospitals. Among the 699 hospitals with more then 300 beds, 85% had teams, compared with 54% for those with 50-299 beds.
Among the 1,500 hospitals with fewer than 50 beds, only 22% reported having a team, but these smaller institutions were excluded from further analysis.
The rate was lowest in the South, with only 51% of hospitals reporting a team, compared with 73% in the Northeast. In addition, 72% of hospitals in the Midwest, and 68% of hospitals in the West said they had a team.
Palliative care has been a topic of controversy since the implementation of the Affordable Care Act, which contains a provision in Medicare that would reimburse doctors for counseling elderly patients on end-of-life issues and palliative care. Opponents to the provision argued that it would encourage doctors to withhold care from elderly patients.
At a policy summit in March, health experts voiced support for increasing palliative care, arguing that it improved the quality of life for elderly patients.
"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said Dr. Allen S. Lichter, a panelist at the summit. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."
Dr. Lichter, chief executive officer of the American Society of Clinical Oncology,* added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope for a cure."
Dr. Diane E. Meier
"Palliative care teams are transforming the care of serious illness in this country because they address the fragmentation of the health care system and put control and choice back in the hands of the patient and family," said CAPC director Dr. Diane E. Meier in a statement. "Hospitals today recognize that palliative care is the key to delivering better quality, coordinated care to our sickest and most vulnerable patients."
Regardless of the controversy among the experts, a CAPC poll showed that 70% of Americans don’t know what palliative care is. The center conducted the poll through a combination of one-on-one interviews with caregivers, Internet focus groups, and a telephone survey of 800 adults aged 25 years and older. Currently, 90 million Americans are living with chronic conditions and that number will only increase as the baby boomers age, CAPC said.
*Correction, 8/18/2011: An earlier version of this story incorrectly identified Dr. Lichter's affiliation.