End of Life / Increasing Access to Hospital Based Palliative Care

Indicator: Percent of California acute care hospitals provide in-patient palliative care

Description: Specialty palliative care services help make certain that hospitalized patients with serious illness receive care that addresses their physical, emotional and spiritual needs. Further, these services work with other health care providers to make sure that the care that is delivered is aligned with patient goals, values and preferences. In the past decade, a growing body of evidence that palliative care improves patient outcomes has led to a steady increase in the number of hospital-based programs nationally. Still, not all hospitals offer such services. Tracking the number of non-specialty, short-stay acute care hospitals in California that offer palliative care is one way of assessing the state’s ability to meet the needs of individuals towards the end of life.

Data Limitations: The main source for prevalence data is the California Office of Statewide Health Planning and Development (OSHPD) Annual Utilization Report of Hospitals (URH), which California hospitals are required to complete. Since 2013, the URH has included a question about the presence of a palliative care (PC) program. (Responses in 2013 reflected presence during calendar year 2012.) Because the question about the presence of a PC program was only recently added, there have been instances when the information reported to OSHPD has been incorrect. An analysis conducted in 2014 showed that responses to the 2013 URH had a very low “false positive” rate (reporting the presence of a PC program when one was not in fact operating) of 1.6%, but a fairly high “false negative” rate (reporting that no PC program existed when in fact a program was in place) of 24%. These numbers improved in 2014, when the false positive rate fell to 0.7% and the false negative rate fell to 16.7%. The data presented in this indicator has not been adjusted from these findings, in order to stay consistent with what is publicly available from OSHPD.

There is little information about the quality of these services. A growing number of programs are seeking Advanced Certification in Palliative Care from The Joint Commission, which certifies adherence to national consensus standards addressing the quality of PC. Still, the certification is not required and has only been available since 2011, so many programs may not be certified. On the other hand, there is tremendous variation in how PC programs are staffed, with resulting variation in the number of patients that can be served, the types of issues that a program can address, and the level of expertise of the PC team members. Thus, the mere presence of a PC program may not be an indicator that all of a hospital’s patients who need PC have access to it, or that the type of PC that is offered adheres to consensus best practices.

Indicator Source: The OSHPD URH (which California hospitals are required to complete). The report includes a question about the presence of a PC program. Responses from all licensed hospitals are made available annually, via the OSHPD web site. As part of ongoing efforts to assess the prevalence of PC programs in the State, CHCF has funded analysis of these data, including identifying responses from non-specialty, short-stay, acute care hospitals (the type of facilities that are most likely to need and offer inpatient palliative care programs.)

Indicator Calculation Methodology: Numerator: number of non-specialty, short-stay acute care hospitals that endorse having a PC program in their response to the OSHPD URH; Denominator: number of non-specialty, short-stay acute care hospitals that complete the OSHPD URH.

Data Collection Methodology: Methodology to create dataset: https://www.oshpd.ca.gov/hid/Products/Hospitals/Utilization/Hosp_Util_Info.html
Form used to collect data: https://www.oshpd.ca.gov/HID/ALIRTS/FormsUserGuides.html#Hospital

Program URL Link: https://oshpd.ca.gov/HID/Hospital-Utilization.html

Geographic Granularity: County

Reporting Cycle: Annually, with preliminary data released in the spring and final data released in the fall

Reporting Lag: Prior calendar year

Indicator Source Changes: OSHPD added the questions addressing presence of a palliative care program in 2013, with the initial set of responses reflecting presence of a PC program in calendar year 2012. Program prevalence data reported for 2011 reflects responses to a survey of acute care hospitals in California conducted by University of California, San Francisco, which achieved a 96% response rate. Report at https://www.avoidreadmissions.com/wwwroot/userfiles/documents/123/david-oriordan-arc-presentation-jan-11.pdf.

National Benchmark Indicator: There are no available, regularly reported data on the prevalence of PC services in non-specialty, short-stay, acute care hospitals nationally

Tags (Keywords): palliative care, hospitalization, end of life, End of Life, EOL, hospital-based palliative care

1. LGHC Task Force Report, https://www.chhs.ca.gov/pages/LGHCTF.aspx

2. CHCF Living Well, Dying Well, https://www.chcf.org/articles/2015/10/living-well-dying-well

3. Dying in America, https://iom.nationalacademies.org/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx

4. CHCF Palliative Care in California, https://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20P/PDF%20PalliativeCareOverview.pdf

5. CHCF Dying in California, https://www.chcf.org/publications/2015/10/dying-calif-status-report