In It Together: How Palliative Care Spread to All of California’s Public Hospitals

By Monique Parrish

Public hospitals in California serve 2.5 million people each year, many of whom have a late-stage illness. For these patients, palliative care, with its specialized focus on relief from the pain, symptoms, and stress of serious illness and goal of improving quality of life, is often the most appropriate care.

In 2008, while 43% of California hospitals had palliative care programs, only 24% of public hospitals (four) had them. Recognizing that a lack of palliative care services in public hospitals impedes appropriate care for underserved populations, CHCF launched a five-year initiative to introduce or expand palliative care in the state’s 17 acute care public hospitals.

The initiative, Spreading Palliative Care in Public Hospitals (SPCPH), drew on the expertise of the California Safety Net Institute (SNI) and the University of California, San Francisco’s Palliative Care Leadership Center (PCLC) to accomplish three main goals:

  • Develop new, sustainable inpatient palliative care programs in California’s public hospitals
  • Provide models for culturally sensitive palliative care services and increase access to palliative care for California’s racial and ethnic minorities
  • Support expansion and enhancement of existing public hospital palliative care programs and create a uniform data collection tool

During Phase I, grants were awarded to 12 facilities to help implement interdisciplinary palliative care consult services where none existed and to expand existing palliative care programs to new areas.

During Phase II, which ran from April 2011 to December 2013, five additional public hospitals received implementation grants that enabled them to focus on developing new palliative care services and participate in the project’s learning community and evaluation.

The project has been a success — it stimulated new programs in 13 facilities and expanded existing ones in four others. The SPCPH initiative, including three projects that arose to respond to challenges faced by participating teams, is chronicled in a report. The report highlights the initiative’s successes and challenges and describes the elements that paved the way for the establishment of sustainable palliative care programs in all of California’s public hospitals.

The complete report is available under Document Downloads.