Palliative care services in California hospitals: program prevalence and hospital characteristics

In 2000, 17% of California hospitals offered palliative care (PC) services. Since then, hospital-based PC programs have become increasingly common, and preferred practices for these services have been proposed by expert consensus.

We sought to examine the prevalence of PC programs in California, their structure, and the hospital characteristics associated with having a program.

A total of 351 acute care hospitals in California completed a survey that determined the presence of and described the structure of PC services. Logistic regression identified hospital characteristics associated with having a PC program.

A total of 324 hospitals (92%) responded, of which 44% (n=141) reported having a PC program. Hospitals most likely to have PC programs were large nonprofit facilities that belonged to a health system, had teaching programs, and had participated in a training program designed to promote development of PC services. Investor-owned sites (odds ratio [OR]=0.08; 95% confidence interval [CI]=0.03, 0.2) and city/county facilities (OR=0.06; 95% CI=0.01, 0.3) were less likely to have a PC program. The most common type of PC service was an inpatient consultation service (88%), staffed by a physician (87%), social worker (81%), chaplain (76%), and registered nurse (74%). Most programs (71%, n=86) received funding from the hospital and were expected to meet goals set by the hospital or health system.

Although the number of hospital-based PC services in California has doubled since 2000, more than half of the acute care hospitals still do not provide PC services. Developing initiatives that target small, public, and investor-owned hospitals may lead to wider availability of PC services.