Survey Shows Sharp Increase in Palliative Care Programs at California Hospitals
Palliative care services promote quality of life and honor patient wishes
Hospital-based palliative care is becoming more readily available as an alternative to costly, unrealistic, or unwanted treatments, according to a new report published by the California HealthCare Foundation (CHCF).
A survey conducted by the National Health Foundation and the University of California, San Francisco (UCSF) Palliative Care Leadership Center, showed that of the 325 responding acute care hospitals, 43% have a palliative care program, a sharp increase since 2000, when only 17% of hospitals offered palliative care consultation services.
“The results of this survey are encouraging,” said CHCF President and CEO Mark D. Smith, M.D., M.B.A. “Providing palliative care in a hospital setting is in some sense a return to an old idea that we have gradually lost sight of — the recognition that an either/or choice between medical treatment and comfort care is neither necessary nor desirable for most people.” Smith presented the survey findings to a meeting of hospital executives sponsored by the Hospital Council of Northern and Central California today.
Hospital-based palliative care programs are relatively new, with 90% of them launched since 2000 and 64% starting up since 2004.
Palliative care is defined as comprehensive, interdisciplinary care that focuses on promoting quality of life for patients living with serious, chronic, or terminal illness, as well as emotional support for their families. It ensures physical comfort and psychosocial support and is provided simultaneously with other appropriate medical treatments.
“In addition to the obvious clinical and humanitarian benefits, providing palliative care in hospitals also happens to make good financial sense,” Smith said. “In many instances, the reductions in hospital costs resulting from the palliative care intervention can meet or exceed the cost of staffing and running the service.”
Avoiding pain and discomfort is the greatest concern among Californians, almost half of whom are likely to die in a hospital. “The typical hospital palliative care patient is 70 years old, and has a principal diagnosis of cancer, although many patients seen by palliative care programs have conditions such as heart disease, stroke, and dementia,” said Steven Z. Pantilat, M.D., director of the Palliative Care Program and Palliative Care Leadership Center at the University of California, San Francisco. “The goal of a palliative care program is to provide the highest quality of care, in accordance with patient wishes, beliefs, and culture.”
Most multidisciplinary teams providing palliative care include a physician (87%), spiritual care professional (81%), social worker (76%), registered nurse (74%), and advanced practice nurse (66%). Teaching hospitals are moving to incorporate palliative care in their training programs for new physicians, with 57% of them having a program today, according to the survey.
“We have been able to manage symptoms and ease the pain of patients with advanced illness at the end of life,” said Susan C. Stone, M.D., director of Palliative Care at the Los Angeles County-USC Medical Center. “This care was not available previously in a cohesive team such as the palliative care service.” Stone said the program, launched in 2006, also has been beneficial for the hospital as it has significantly decreased length of stay and use of intensive care services. “Our cost avoidance during the first year alone was over eight million dollars,” she said.
According to the survey data, Los Angeles has the greatest number of hospital-based palliative care programs (38) and Sacramento the highest proportion (67%), while Orange County hospitals are the least likely to offer a program. While growth of palliative care services has been sharply on the rise in recent years, there is potential for a slowdown. Of the hospitals currently without palliative care services who responded to the survey, only 4% said they had plans to implement such services in the future.
“There are challenges to developing a palliative care service, including professional development and training of physicians, staffing capabilities, and financial considerations,” said Pantilat. “But many California institutions, large and small, across all care settings, have proved that the barriers to developing and sustaining palliative care services can be overcome.”
About the California Health Care Foundation
The California Health Care Foundation is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford.