Availability of Palliative Care in Long-Term Acute Care Hospitals

doi:10.1016/j.jamda.2021.04.007

. 2021 Oct;22(10):2207-2211.

doi: 10.1016/j.jamda.2021.04.007. Epub 2021 May 7.

Availability of Palliative Care in Long-Term Acute Care Hospitals

Nathan Sumarsono¹, Rebecca L Sudore², Alexander K Smith², Steven Z Pantilat³, Wendy G Anderson⁴, Anil N Makam⁵

Affiliations

¹ University of Texas Southwestern School of Medicine, Dallas, TX, USA.
² Division of Geriatrics, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
³ Division of Palliative Medicine, University of California, San Francisco, CA, USA.
⁴ Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA; Supportive and Palliative Care Program, San Francisco General Hospital, University of California, San Francisco, CA, USA.
⁵ Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, CA, USA. Electronic address: [email protected].

PMID: 33965406
PMCID: PMC10186213
DOI: 10.1016/j.jamda.2021.04.007

Availability of Palliative Care in Long-Term Acute Care Hospitals

Nathan Sumarsono et al. J Am Med Dir Assoc. 2021 Oct.

. 2021 Oct;22(10):2207-2211.

doi: 10.1016/j.jamda.2021.04.007. Epub 2021 May 7.

Authors

Nathan Sumarsono¹, Rebecca L Sudore², Alexander K Smith², Steven Z Pantilat³, Wendy G Anderson⁴, Anil N Makam⁵

Affiliations

¹ University of Texas Southwestern School of Medicine, Dallas, TX, USA.
² Division of Geriatrics, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
³ Division of Palliative Medicine, University of California, San Francisco, CA, USA.
⁴ Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA; Supportive and Palliative Care Program, San Francisco General Hospital, University of California, San Francisco, CA, USA.
⁵ Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, CA, USA. Electronic address: [email protected].

PMID: 33965406
PMCID: PMC10186213
DOI: 10.1016/j.jamda.2021.04.007

Abstract

Objective: To determine the availability of palliative care programs in long-term acute care hospitals (LTACHs) DESIGN: Cross-sectional analysis using the 2016 American Hospital Association (AHA) Annual Survey.

Setting and participants: LTACHs in the United States.

Method: We used descriptive analyses to compare the prevalence of palliative care programs in LTACHs across the United States in 2016. For LTACHs without a program, we also examined palliative care physician capacity in regions where those LTACHs resided to evaluate if expertise existed in those regions.

Results: One-third (36.5%) of 405 LTACHs (50.6% response rate) self-reported having a palliative care program. Among LTACHs without palliative care, 42.4% were in regions with the highest palliative care physician capacity nationwide.

Conclusions and implications: LTACHs care for patients with serious and prolonged illnesses, many of whom would benefit from palliative care. Despite this, our study finds that specialty palliative care is limited in LTACHs. The limited palliative care availability in LTACHs is mismatched with the needs of this seriously ill population. Greater focus on increasing palliative care in LTACHs is essential and may be feasible as 40% of LTACHs without a palliative care program were located in regions with the highest palliative care physician capacity.

Keywords: LTACH; Long-term acute care; health policy; health services; palliative care.

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Conflict of interest statement

Disclosures/Conflicts of Interest: The authors otherwise declare that they have no competing interests.

Figures

**Figure 1.. Palliative Care Physician Capacity for the 85 Hospital Referral Regions with at least 1 LTACH that Did Not Report Having a Palliative Care Program.**
Deciles are defined according to palliative care physician capacity across all 306 HRRs in the United States, in order to provide a national benchmark of palliative care physician capacity for the 85 HRRs containing at least 1 LTACH without a palliative care program. HRRs shaded in dark gray represent HRRs that did not include an LTACH without a palliative care program.

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References

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1. Long-Term Care Hospital PPS | CMS. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCa.... Accessed September 22, 2020.
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[1] Liu K, Baseggio C, Wissoker D, et al. Long-Term Care Hospitals Under Medicare: Facility-Level Characteristics. Health Care Financ Rev 2001;23:1–18. - PMC - PubMed

[2] Liu K, Baseggio C, Wissoker D, et al. Long-Term Care Hospitals Under Medicare: Facility-Level Characteristics. Health Care Financ Rev 2001;23:1–18. - PMC - PubMed

[3] Long-Term Care Hospital PPS | CMS. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCa.... Accessed September 22, 2020.

[4] Long-Term Care Hospital PPS | CMS. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCa.... Accessed September 22, 2020.

[5] Scheinhorn DJ, Hassenpflug MS, Votto JJ, et al. Ventilator-dependent survivors of catastrophic illness transferred to 23 long-term care hospitals for weaning from prolonged mechanical ventilation. Chest 2007;131:76–84. - PubMed

[6] Scheinhorn DJ, Hassenpflug MS, Votto JJ, et al. Ventilator-dependent survivors of catastrophic illness transferred to 23 long-term care hospitals for weaning from prolonged mechanical ventilation. Chest 2007;131:76–84. - PubMed

[7] Hall WB, Willis LE, Medvedev S, et al. The Implications of Long-Term Acute Care Hospital Transfer Practices for Measures of In-Hospital Mortality and Length of Stay. Am J Respir Crit Care Med 2012;185:53–57. - PMC - PubMed

[8] Hall WB, Willis LE, Medvedev S, et al. The Implications of Long-Term Acute Care Hospital Transfer Practices for Measures of In-Hospital Mortality and Length of Stay. Am J Respir Crit Care Med 2012;185:53–57. - PMC - PubMed

[9] Long Term Hospital Care Coverage. https://www.medicare.gov/coverage/long-term-care-hospital-services. Accessed September 22, 2020.

[10] Long Term Hospital Care Coverage. https://www.medicare.gov/coverage/long-term-care-hospital-services. Accessed September 22, 2020.

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Availability of Palliative Care in Long-Term Acute Care Hospitals

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Availability of Palliative Care in Long-Term Acute Care Hospitals

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Affiliations

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Conflict of interest statement

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