Abstract
•Explain the prevalence of palliative care programs in US hospitals and how this has changed over time.•Discuss the characteristics of hospitals that implemented palliative care programs during the period and the characteristics of those that closed programs during the period. Cross-sectional studies have identified hospital size, tax status, and region as predictors of palliative care presence in hospitals. However, little is known regarding longitudinal changes in palliative care program adoption and closure and whether characteristics of hospitals newly establishing palliative care programs differ from historical adopters. Identify the organizational and regional characteristics associated with hospitals with newly established palliative care programs and those that closed programs between 2013 and 2016. We linked the American Hospital Association Annual Survey to the National Palliative Care Registry for 2013 and 2016. We categorized hospitals as newly establishing a palliative care program, closing a program, or no change. We used 3 multivariate logistic regressions to identify factors associated with each category. Nationally, the proportion of hospitals with 50 or more beds with a palliative care program increased from 67% in 2013 to 78% in 2016. A total of 278 hospitals established palliative care programs and 61 hospitals closed programs during this period. The proportion of for-profit hospitals with palliative care increased from 23% to 45% compared with nonprofit hospital increase from 78% to 88%. Hospitals with new vs established programs were more likely to be smaller (AOR 8.41, 95% CI 5.49-12.89 for 50-149 vs >300 beds; AOR 3.75, 95% CI 2.43-5.79 for 150-300 vs >300 beds), for-profit (AOR 7.45, 95% CI 4.95-11.19), sole community providers (AOR 3.36, 95% CI 1.97-5.73), and in the South Atlantic. Hospitals that closed palliative care programs had similar characteristics to hospitals that newly established programs. Palliative care program implementation is volatile among for-profit and smaller hospitals and varies by region. The impact of these changes on access to palliative care remains a critical area for future research.
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