WebMD Medical News
Daniel J. DeNoon
Laura J. Martin, MD
Oct. 5, 2011 -- Most people with serious illness -- and half of their caregivers -- may not get the care they need.
The support chronically ill patients and their families need is called palliative care. It's a team-based approach that adds layers of support and coordinates the often fragmented medical services patients need.
The focus isn't limited to patients who are dying. Palliative care actually can improve survival for seriously ill patients. The approach not only helps patients but also saves money. More and more hospitals are deploying palliative care teams -- but not enough to meet the need.
To highlight the issue, a new report grades states on how many of their hospitals provide palliative care. It's based on a survey of 2,489 U.S. hospitals by R. Sean Morrison, MD, director of the National Palliative Care Research Center, and Diane E. Meier, MD, director of the Center to Advance Palliative Care.
Morrison and Meier find that 85% of large hospitals with more than 300 beds and 63% of U.S. hospitals with more than 50 beds have a palliative care team. That gives the nation an overall "B" grade.
But just having a palliative care team doesn't mean patients in these hospitals always get palliative care.
"Now a patient does not get palliative care unless the primary doctor requests a consultation from the team," Meier tells WebMD. "In this stage in the evolution, families and patients need to be informed consumers and need to demand the quality of care they should have."
Meier's organization recently commissioned a poll showing that nine out of 10 people don't have any idea what palliative care is. But once it's explained to them, 92% of people say they would want it for themselves or for their loved ones.
Doctors are focused on treating patients' illness. An oncologist, for example, is working with all his or her might to treat a patient's tumor. He or she may not ask about your trouble sleeping, your skin rash, your depression, or the fact that your spouse is exhausted by taking care of you and your children.
"It is difficult," Meier says. "If you or a family member are ill, you don't feel empowered. You are exhausted and you are scared. You don't feel like fighting this broken health care system. But at this stage of palliative care, this is exactly what you have to do in many hospitals."
Of course, you can't get palliative care from a hospital that does not offer it.
Morrison and Meier graded states on the percentage of hospitals that have palliative care teams. They counted only hospitals with 50 or more beds, as palliative care savings may not offset costs for very small hospitals.
States got an A for having palliative care teams in 83% or more of their hospitals, a B for 61% to 80% of hospitals, a C for 42% to 60% of hospitals, a D for 28% to 38% of hospitals, and an F for 0% to 20% of hospitals.
States receiving an A grade
States receiving a B grade
States receiving a C grade
States receiving a D grade
States receiving an F grade
SOURCES:Center to Advance Palliative Care: "Report Card: America's Care of Serious Illness."Diane E. Meier, MD, director, Center to Advance Palliative Care; director, palliative care institute, Mount Sinai School of Medicine, New York.
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