Most Patients in US Have Access to Palliative Care

Lara C. Pullen, PhD

February 05, 2018

The United States now has 1800 hospitals with palliative care programs, which means that more than 80% of US patients who are hospitalized for serious illness have access to palliative services, according to a review of drivers of palliative care.

The researchers conclude that purposeful technical assistance can be used to aid the rapid diffusion of high-value healthcare innovation. "Dissemination of high-value, low-revenue innovations in health care takes dedicated expertise, persistence, and ingenuity," they write.

In the case of palliative care, tens of millions of dollars of philanthropic support catalyzed the innovation, dissemination, and professionalization of the field.

The team-based approach of palliative care aims to relieve the pain, symptoms, and stress of serious illness. The current US healthcare system financially rewards centers that reliably generate new revenue and incorporate new technology, tests, procedures, pharmaceuticals, and devices.

Thus, the fee-for-service approach that dominates healthcare in the United States seems to run counter to palliative care. Yet, the rapid and voluntary adoption of the high-value program of palliative care occurred within this financial landscape.

J. Brian Cassel, PhD, an assistant professor of hematology, oncology, and palliative care at Virginia Commonwealth University in Richmond, and colleagues published their findings online February 5 in Health Affairs.

The authors note that US hospitals with more than 50 beds experienced a threefold increase in palliative care programs from 2000 to 2015. In 2000, 25% of these institutions had a palliative care program and, by 2015, the number had risen to 75%. Moreover, 90% of hospitals with more than 300 beds and 100% of the National Cancer Institute's Comprehensive Cancer Centers now have palliative care services.  

Social Entrepreneurship

The Robert Wood Johnson Foundation created the Center to Advance Palliative Care (CAPC) in late 1999 with the intention of improving patient care, specifically by increasing access to palliative care. The Robert Wood Johnson Foundation partnered with other foundations and private philanthropists to drive progress toward their vision.

The movement began with the question: Why is the healthcare system so bad at providing care during serious illness? The response to this question drove the articulation of a plan for a transformed approach to the care of people with serious illness. The approach centered on the priorities and concerns of the patient and the family.

CAPC built and tested prototype models of early palliative care programs. This process led to the development of a palliative standard of care that they promoted through several means: technical assistance, online and in-person training, train-the-trainer approaches, coaching, regulatory and accreditation requirements, and changes in payment policy. Much of this work was performed by the CAPC's Palliative Care Leadership Training Centers and a training initiative, which ultimately provided educational and technical assistance to two thirds of the palliative care programs throughout the United States.

The authors describe the accomplishment as particularly remarkable given that the US healthcare market is driven by volume incentives, which are not compatible with palliative care. Social entrepreneurship was thus able to overcome the substantial inherent barriers to the widespread adoption of palliative care via strategic dissemination of dedicated expertise backed by persistence and ingenuity.

"Building on increased attention and demand from the public, policy makers, and health care providers, the diffusion of palliative care programs is transforming serious illness care in the [United States]," the researchers conclude.

The authors have disclosed no relevant financial relationships.

Health Aff. Published online February 5, 2018. Abstract

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