Gaps in the Use of Palliative Care in US Hospitals (FR461D)

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•Describe the prevalence of patients in US academic medical centers who are appropriate for palliative care referral.•Identify the varying levels of palliative care referrals, consultations, and services among the hospitals that participated in the study.•Discuss the individual, programmatic, and organizational characteristics that result in differing levels of palliative care coverage for patients appropriate for palliative care referral. The approach to care for individuals with serious, life-threatening illness seems to be shifting. However, the extent of unmet need for palliative care in US hospitals remains largely unknown. We conducted a multi-site cross-sectional, retrospective point prevalence analysis to determine the size and characteristics of the population of inpatients at 33 US hospitals who were appropriate for palliative care referral, as well as the percentage of these patients who were referred for and/or received palliative care services. Patients appropriate for palliative care referral were defined as adult (≥18 years) patients with any diagnosis of a poor-prognosis cancer, New York Heart Association Class IV congestive heart failure, or oxygen-dependent chronic obstructive pulmonary disease who had inpatient status in one of 33 hospitals on May 13, 2014. Qualitative assessment involved interviews of palliative care team members and non-palliative care frontline providers. Nearly 19% of inpatients on the point prevalence day were deemed appropriate for palliative care referral. Of these, approximately 39% received a palliative care referral or services. Delivery of palliative care services to these patients varied widely among participating hospitals, ranging from approximately 12% to more than 90%. Factors influencing differences in referral practices included non-standardized perceptions of referral criteria and variation in palliative care service structures. This is the first multi-site study designed to estimate the prevalence of hospitalized patients appropriate for palliative care referral in US hospitals. The findings demonstrate the need to expand the availability of palliative care services, including primary palliative care delivered by frontline providers.