End of Life / Increasing Access to Hospital Based Palliative Care

Increasing Access to Hospital Based Palliative Care2021-03-26T04:58:24+00:00

Millions of Californians haven’t communicated their choices for end-of-life care.1

End of life is one of the most difficult stages of life and is in need of attention to improve the care and experience of individuals who are dying. Many patients at the end of life could benefit from palliative care.

Palliative care is specialized, team-based care that focuses on relieving symptoms and improving quality of life for both the patient with a serious illness, and the patient’s family.1 It can be provided at any stage of a serious illness, and can be provided together with curative treatment. Further, providers of these services work with other health care team members to make sure that the care that is delivered is aligned with patient goals, values, and preferences.

Tracking the percentage of California hospitals that provide in-patient palliative care helps to make sure that hospitalized patients with serious illness receive care that meets their physical, emotional, and spiritual needs.

Indicator Progress

In 2012 (baseline year), 37.3% of California hospitals provided in-patient palliative care. The most recent data available show 51.9% (2014). We hope to reach a target of 80.0% or higher by 2022.

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More Data

Access to Hospital Based Palliative Care

Note: The data source has changed from the original LGHC 2012 Task Force Report as the original data source is no longer available.

Baseline

37.3%

Current Rate

51.9%

Target

80.0%

Indicator Highlights

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80% want to talk

In a 2011 survey by the California HealthCare Foundation (CHCF), nearly 80% of Californians said they would “probably or definitely want to talk with their doctor if they were seriously ill”2

7% discussed with doctor

Although most patients said they want to discuss these issues, only 7% said their doctor ever raised the topic.2

23% written down

Only 23% of Californians surveyed said they had written down their end of life wishes.2

In the past ten years, 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.

Key factors affecting access to in-patient palliative care programs include availability of certified/designated palliative care providers and focus and prioritization of palliative care.4

Disparities & Trends

In California, the availability of in-patient palliative care has been increasing in recent years. The Let’s Get Healthy California indicator shows that 52% of hospitals currently offer palliative care programs, moving toward the 80% target for 2022.

Note that alternative measures for this topic have found that 74% of California’s hospitals with 50 or more beds had palliative care programs in 2012 or 2013.

Some hospitals, particularly smaller hospitals or those in rural parts of the State, do not yet have palliative care programs.5

Percent of California Hospitals Providing In-patient Palliative Care by City


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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: http://www.oshpd.ca.gov/hid/Products/Hospitals/Utilization/Hosp_Util_Info.html
Form used to collect data: http://www.oshpd.ca.gov/HID/ALIRTS/FormsUserGuides.html#Hospital

Program URL Link: http://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 http://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

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