Prevalence and structure of palliative care services in California hospitals.
BACKGROUND
Most Americans die in hospitals where shortcomings in end-of-life care are endemic. Hospital-based palliative care services can improve the care of these patients, yet there are limited data regarding the availability of such services. We sought to determine the prevalence of palliative care services in California hospitals.


METHODS
We conducted a cross-sectional survey of a random sample of 25% of all California hospitals. We recorded the percentage of hospitals reporting current or planned palliative care consultation services or inpatient palliative care units.


RESULTS
We collected data from 107 (96%) of 112 hospitals. Only 17% of hospitals have a palliative care consult service, and 6% have an inpatient palliative care unit. Nearly all services are multidisciplinary. Twenty percent of hospitals have a contract to provide inpatient hospice beds, 19% have an outpatient-based hospice service affiliated with the hospital, and 74% offer bereavement services. Half of all palliative care services are funded exclusively by the hospital. Thirty-eight hospitals (36%) reported an interest in developing palliative care services.


CONCLUSIONS
Few California hospitals currently have palliative care services, though more express interest in developing them. Bereavement and hospice services are more common and offer opportunities for increasing the number of palliative care services in hospitals. Further studies are needed to characterize palliative care services more fully and to assess the quality of care provided by these services.
Program in Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of California San Francisco School of Medicine, 521 Parnassus Avenue, Suite C-126, San Francisco, CA 94143, USA. stevep@medicine.ucsf.edu
Steven Z
SZ
Pantilat
J Andrew
JA
Billings
D002140:California; D003430:Cross-Sectional Studies; D006282:Health Personnel / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D010166:Palliative Care / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D000078329:Workforce