Palliative care: advancing or deficient?

In an updated report1 that appears in a recent issue of Journal of Palliative Medicine, researchers examined the ability to accessibility of palliative care in U.S. hospitals.

Within the last decade, the number of palliative teams has doubled, and it continues to grow. Even with improvements and advancements in the field, millions of Americans facing serious illness still don't have access to palliative care from the point of diagnosis and throughout the course of illness, so more progress is still needed.

"It is crucial that we understand variation in access to palliative care at the state level in order to help both the public and policymakers increase the availability of these services for all Americans in need," says Diane Meier, MD, FACP, director of the Center to Advance Palliative Care at Mount Sinai School of Medicine, New York City, and one of the authors of the report.

The original report was published in 2008, and the updated report shows that progress might be slow, but it is steady. "The nation overall gets a 'B' grade, up from a 'C,' when the report was first released in 2008. Out of a total of 2,489 hospitals nationwide, about 1,500 provide palliative care services," says Meier.

While findings from the 2011 demonstrate considerable improvement in palliative care from the 2008 report, there are significant variations from state-to-state. "The report gives seven states plus the District of Columbia an A: Maryland, Minnesota, Nebraska, Oregon, Rhode Island, Vermont, and Washington," she says. That list is up from only three states, Vermont, Montana and New Hampshire, that received an A in 2008. "More than half of the 50 states received a grade of B. Seven states improved from a D to a C," including Georgia, Kentucky, New Mexico, Texas, South Carolina, Louisiana, and Wyoming," she says.

According to the report, Nevada saw dramatic gains, rising from a D to a B grade. "Only two states — Delaware and Mississippi — got an F. Oklahoma, Alabama, and Arkansas improved from an F in the last report card to a D in 2011," Meier adds. The highs and lows of Nevada and Delaware came to great surprise for the authors. "On a regional level, the West and Northeast went from a C to a B. The Midwest and South remained the same," she says, receiving a B and C, respectively.

Hospitals were included in the study if they admitted adult patients and the majority of admissions were identified as general medical-surgical, obstetrics/gynecology, cancer, or cardiac. Hospitals were excluded from the study if they were considered rehabilitation, psychiatric, or eye, ear, nose and throat hospitals; subacute and chronic care facilities; pediatric hospitals; fell under federal control (e.g., Department of Veterans Affairs); were located outside of the 50 states and the District of Columbia; or did not respond to the American Hospital Association (AHA) survey, which was the basis for the results.

Studies continue to suggest that in states with more hospital palliative care teams, patients are less likely to die in the hospital, are likely to spend fewer days in intensive care, and have better pain management and higher satisfaction with their healthcare. "Some studies have reported that palliative care may also prolong life. And beyond patient benefits, the overall cost savings to hospitals have been well documented," says Meier.


  1. Morrison S, Meier D. America's care of serious illness: A state-by-state report card on access to palliative care in US hospitals. J Pall Med 2011; 14:1,094-1,096.


  • Diane Meier, MD, FACP, Director of the Center to Advance Palliative Care, Mount Sinai School of Medicine, New York City. E-mail:

  • To download a free copy of the full report, "A State-by-State Report Card on Access to Palliative Care in Our Nation's Hospitals," visit