Health Care State Rankings 2011

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In the east and west south-central regions, prevalence of palliative care teams in for-profit hospitals averaged 10 percent and 18 percent, respectively. Reasons for differences in palliative care availability in for-profit as compared to nonprofit and public hospitals are unknown.

This Report Card demonstrates continued steady growth in the number of hospital palliative care programs in the United States. Access to palliative care remains uncertain, however, and depends upon accidents of geography. Millions of people with serious illness still do not receive the care they need. One-third of hospitals report no palliative care services of any kind, and access to palliative care in community settings home, nursing home, assisted living is limited for people who are not hospice eligible actively dying.

Palliative care is a rapidly growing medical specialty aimed at improving quality of life for persons with serious illness and their families. Although palliative care is associated with better quality of care and lower costs, access to it is currently limited mostly to hospitals and, for those who are dying soon, hospice.

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Making palliative care available to the much larger population of the seriously ill who are neither hospitalized nor dying in the community settings where they receive care is the single largest opportunity to improve value in the U. Patients and families coping with serious illness want and need access to the quality of life that palliative care provides.

The timing, demand and opportunity to expand access to palliative care are unprecedented. The public and private health care markets are under pressure to provide higher-quality care for the growing number of aging Americans who face serious and chronic disease. The emphasis on coordinated quality care has stimulated interest among private insurers and health care networks in solutions that are person- and family-centered and have proven cost effectiveness.

Public and private health care payers are moving away from fee-for-service siloed payment systems that confound the ability of hospitals, doctors, nurses and other health care providers to coordinate the care they give their patients. Payment changes based on quality of care are pushing communities and health systems to work together to reorganize how and where care is delivered, to reach patients where they live and not just in the hospital.

This new environment has led to widespread recognition by payers, providers and other influential stakeholders that palliative care is an evidence-based practical solution to improving value that can be widely implemented. Key stakeholders, including the Institute of Medicine, have recognized a need for additional training in palliative care for most doctors and nurses based on the value this care provides to patients and their families. Barriers to palliative care access remain in three key areas: workforce, research and payment models linked to quality measures.

Recommendations for federal policy actions are made on the following page. Lawmaker interest in promoting wider patient access to palliative care is growing. Widely supported legislation pending in Congress would facilitate research, professional development and public education in palliative care. In addition, numerous state governments are developing new initiatives and passing supportive legislation.

Interest in expanding access to palliative care is growing. Below are recommendations for federal policy actions that could help overcome these barriers. Establish palliative care centers that would develop and disseminate curricula relating to palliative care, support the training and retraining of clinicians in palliative care skills, support continuing education and provide students with clinical training in appropriate sites of care.

Establish career incentive awards for palliative care physicians, nurses, social workers and chaplains to foster interest in entering the field of palliative care, and to support clinician educators who can integrate palliative care into medical, nursing school and postgraduate training curricula.

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Reform Graduate Medical Education GME funding to support residency slots in high-value specialties like palliative care, and explore a GME quality-improvement program to create incentive for skills training in patient-centered communication, team-based care and pain and symptom management for all physicians, regardless of specialty. A competent workforce is a prerequisite to delivery of quality palliative care across the health care continuum to the millions of seriously ill patients who could benefit from it.

Large-scale training programs are needed to meet a chronic shortage of palliative care specialists and fill a gap in basic palliative care knowledge and skills among clinicians of all types. This number is expected to increase over the next 25 years as the baby boomer generation reaches old age. However, recent data show there is only one palliative care physician for every 1, patients living with serious or life-threatening illness.

Historically there has been little focus on palliative care education in medical and nursing schools. The majority of health professionals today have had little to no training in pain and symptom management, skilled communication or helping patients negotiate our health care system. The need to strengthen the palliative care skills of the health care workforce has never been more urgent.

Supportive policy is needed to make training in basic palliative care competencies a requirement for all clinicians. Support the development of innovative palliative care delivery models. Develop specific program announcements and requests for applications targeted to palliative care research priorities. These studies should include populations with functional and cognitive impairment and frailty.

Implementation studies should have a plan for knowledge translation into practice. University of New South Wales. University of Padua. University of Paris Descartes Paris 5. University of Southampton. University of Tennessee - Knoxville. University of Tsukuba. University of Vienna. University of Wageningen. University of Warwick.

University of Waterloo. Virginia Commonwealth University. Virginia Polytechnic Institute and State University. Autonomous University of Madrid. Brandeis University. Chalmers University of Technology. Charles University in Prague. Claude Bernard University Lyon 1. Complutense University of Madrid.

Dalhousie University. Dresden University of Technology. Fudan University. Keio University. King Saud University. Korea Advanced Institute of Science and Technology. Lancaster University. Laval University.

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Macquarie University. Medical University of Vienna. Nanjing University. Nanyang Technological University. National and Kapodistrian University of Athens. Newcastle University. Norwegian University of Science and Technology. Paul Sabatier University Toulouse 3. Peking University. Polytechnic Institute of Milan. Queen Mary, U. Queen's University. Rensselaer Polytechnic Institute. Royal Institute of Technology.

Shanghai Jiao Tong University. Simon Fraser University. State University of Campinas. State University of New York at Buffalo.

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Technical University of Berlin. The George Washington University.

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The Hong Kong Polytechnic University. The University of Adelaide. The University of Auckland.

The University of Connecticut - Storrs. The University of Hong Kong. The University of New Mexico - Albuquerque. The University of Reading. Trinity College Dublin. Umea University. University of Aberdeen.

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University of Antwerp. University of Barcelona.

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