Eighty-One Percent of Hospitalized Patients in the United States Have Access to Palliative Care: A New Measure of Access and Insights into Remaining Barriers

Abstract

Background:

Access to specialized palliative care (SPC) has improved but continues to be a concern. For-profit (FP) hospitals are less likely to offer SPC than hospitals with other ownership types, though the reason for this is not well understood.

Objectives:

The primary objective was to introduce a new measure of access, percent of patients admitted to hospitals offering SPC, and to estimate SPC access for each state. Secondary objectives were to examine availability of other low revenue services as well as high-revenue services, and to explore availability of SPC within multihospital systems.

Design:

The 2021 American Hospital Association Annual Survey provided data on hospital characteristics and service offerings. These data were used to estimate access measures. Correlations between ownership type and service offering were estimated using logistic regression.

Subjects:

Acute care hospitals in the United States.

Results:

Nationally 81% of hospitalized patients were admitted to hospitals offering SPC. Only 48% of hospitals offered these services. Not-for-profit and public hospitals had higher adjusted odds of offering SPC and other low-revenue, high-value services (adjusted odds ratios ranged from 1.33 to 4.50). Their odds of offering most high-revenue, low-value services were lower or did not have statistically significant differences. Multihospital FP systems varied in the percent of their hospitals offering SPC.

Conclusions:

The majority of hospitalized patients have access to SPC, even in many states where less than 50% of hospitals offer it. Financial characteristics of SPC contribute to its low uptake by for-profit hospitals. Multihospital systems differ in their adoption of SPC.