Variability in Access to Hospital Palliative Care in the United States

by Benjamin Goldsmith; Jessica Dietrich; Qingling Du; R. Sean Morrison

Jan 1, 2008
This article examines geographic variance in patient and medical trainee access to palliative care.
  • Factors significantly associated with hospital palliative care include geographic location, owning a hospice program, having an American College of Surgery approved cancer program, percent of persons in the county with a university education, and medical school affiliation.
  • For-profit and public hospitals were significantly less likely to have hospital palliative care when compared with nonprofit institutions.
  • States with higher hospital palliative care penetration rates were observed to have fewer Medicare hospital deaths, fewer intensive care unit/cardiac care unit (ICU/CCU) days and admissions during the last 6 months of life, fewer ICU/CCU admissions during terminal hospitalizations, and lower overall Medicare spending/enrollee.
  • Overall, medical students have high rates of access to hospital palliative care although complete penetration into academic settings has not occurred.
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