U.S. hospital palliative-care teams suffer staffing gaps

(Reuters Health) - Only a quarter of U.S. hospitals had complete, paid palliative-care teams to help seriously ill patients manage pain, address emotional and spiritual needs and discuss end-of-life wishes, a new study shows.

The Joint Commission, the major accreditor of American hospitals, calls on hospitals to deliver palliative care to Americans suffering from chronic and serious illnesses with paid teams including a doctor, a nurse, a social worker and a chaplain.

But according to a study published in Health Affairs, data from 410 hospital programs in 2012 and 2013 showed gaping holes in the service.

“A lot of these programs are running on a shoestring,” lead author Joanne Spetz said in a telephone interview. Spetz, an economics professor, directs the Health Workforce Research Center at the University of California, San Francisco.

She said her study was the first to mine hospital palliative-care staffing data, and she was struck by the fact that about half of the programs failed to pay for a registered nurse or a social worker.

About a third of the programs had no paid medical doctor or osteopath, and nearly two-thirds had no funded chaplain, the study found.

Dr. Robert Arnold believes that some hospitals probably have beefed up their palliative-care services since 2013, the last year the researchers examined, he said in a phone interview.

“My guess is that it’s better now, and even if it’s better, it’s still inadequate to do the kind of culture change that seriously ill patients need,” he said. Arnold is a palliative-care physician and professor at the University of Pittsburgh School of Medicine in Pennsylvania and was not involved with the current study.

When Arnold was a resident 30 years ago, there were no palliative-care programs, he said.

In 1998, only 15 percent of American hospitals with more than 50 beds had palliative-care programs. By 2013, the number rose to 67 percent, the authors of the current study write.

The number of programs has grown in response to mounting evidence that palliative care improves patient outcomes and reduces medical costs, the study authors say.

A 2015 study found that millions of Americans suffering from serious illness lack access to palliative care and that palliative-care programs were significantly more common in not-for-profit and public hospitals than in for-profit hospitals.

Regional variation in palliative care in the U.S. was also striking in the 2015 study. In New England, 88 percent of hospitals had palliative-care programs, as did 77 percent of hospitals in the Pacific and mid-Atlantic states. But in the south-central regions, only about 40 percent of hospitals had programs.

Palliative care includes hospice care, but while hospice focuses strictly on terminally ill patients who have opted to forego curative treatment, palliative care seeks to help people living with chronic and debilitating disease. Palliative care aims to improve quality of life for patients and their family caregivers by addressing a variety of problems, including pain, shortness of breath, fatigue and depression.

“It’s almost a no-brainer that palliative-care services need to be provided,” Spetz said. “The evidence has been there for a decade.”

Although researchers have found that palliative-care services save money, health insurers have been slow to reimburse for them, she said.

“Spending 45 minutes with a patient to talk about their holistic needs doesn’t pay in medicine,” Spetz said.

Arnold agreed. “We’re still focused almost entirely on diseases and not on function,” he said.

“It’s going to take the federal government saying we need to really support this kind of medicine,” he said. “The federal government is beginning to develop and test models. Are they going to align the incentives to support these models?”

SOURCE: Health Affairs, online September 7, 2016.