Palliative care exploding in U.S. hospitals (AP) - PulmCCM
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Jun 222012
 
policy ethics education review lung cancer review critical care review  Palliative care exploding in U.S. hospitals (AP)

Hospitals added palliative care services at a feverish pace throughout the 2000s, the Associated Press reported in a piece picked up by news outlets across the U.S. in June. While 658 hospitals reported having palliative care programs in 2000, 1,568 reported they offered palliative care services in 2009 — that’s over 60% of the hospitals in the U.S. The Center to Advance Palliative Care, an advocacy organization, supplied the statistics for the article.

It’s not clear why hospitals have rushed to adopt palliative care services (although I’m glad they have). The experts quoted believe it’s due to “reduced lengths of stay” reported in studies examining the impact of palliative care on outcomes. Isolated studies and some reviews promote the idea that palliative care reduces lengths of stay and medical care costs. The watershed study by Ternel et al in NEJM 2010, showing palliative care improved outcomes from metastatic lung cancer, gave the entire specialty a huge boost. However, palliative care’s overall effects on outcomes are debated; palliative care doesn’t consistently reduce lengths of stay, as reported in this 2010 review in the palliative care literature, and the largest randomized trial of palliative care in ICUs by Curtis et al (AJRCCM 2010) showed no detectable benefit.

Not only do palliative care services not generate the all-important invasive procedural-based dollars that keep hospitals’ balance sheets right side up, they can actually result in just the opposite — reduced revenues from the sickest patients, who can be the most lucrative to the hospital. An example mentioned is the palliative care team talking a patient with end-stage congestive heart failure out of getting a left ventricular assist device placed — a procedure that would bring tens of thousands of dollars in revenue.

Palliative care has continued to struggled for acceptance among peer physicians, especially those of the old school. The NYT did a great story on this in one of its blogs in March — in which a surgeon recently said to a palliative care doc who was encouraging implementation of the surgeon’s patient’s valid advance directive: “You would have been hung in World War II for doing what you are doing now.”

Who knows? Maybe hospitals are rushing to adopt palliative care services, despite their expense and the resistance from some physicians, because relieving suffering is the right thing to do at a hospital — and because it feels like a good idea to have someone around, thinking about how to do it best.

Matt Sedensky, Associated Press, “Hospitals add palliative teams at feverish pace.

Paula Span, New York Times, “Among Doctors, a Fierce Reluctance to Let Go.

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