A State-Level Assessment of Hospital-Based Palliative Care and the Use of Life-Sustaining Therapies in the United States.

Abstract

It is unknown how the prevalence of hospitals with palliative care programs (PCPs) at the state level in the United States correlates with the treatment of critically ill patients. We examined the relationship between state-level PCP prevalence and commonly used treatments for critically ill patients as well as other public health metrics. We compiled state-level data for the year 2011 from multiple published sources. These included the poverty rate from the U.S. Census, public health measures such as the number of primary care physicians per 100,000 persons from America's Health Ranking website, and state-level rates for a series of validated ICD-9 (International Classification of Diseases, 9th Revision) procedure codes used for critically ill patients (e.g., prolonged acute mechanical ventilation [PAMV]) from the State Inpatient Databases (SID), Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality. State-level percentages of PCPs came from a published report by the Center to Advance Palliative Care (CAPC). We used the Kruskal-Wallis test and Pearson's correlation coefficient for statistical inference. State-level poverty rates were negatively correlated with the percent of hospitals with PCPs: r = -0.39, p = 0.005. States with more hospital-based PCPs had significantly lower rates of PAMV, tracheostomies, and hemodialysis but higher rates of nutritional support than states with fewer PCPs. States with more poverty and/or at high risk for delivering inefficient health care had fewer hospital PCPs. Hospital-based PCPs may influence the frequency of some interventions for critically ill patients.