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Health Aff (Millwood). 2016 Sep 1;35(9):1690-7. doi: 10.1377/hlthaff.2016.0113.

Few Hospital Palliative Care Programs Meet National Staffing Recommendations.

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Joanne Spetz ( is a professor of economics at the Philip R. Lee Institute for Health Policy Studies and the Healthforce Center at the University of California, San Francisco (UCSF).
Nancy Dudley is a VA Quality Scholars fellow with the UCSF Department of Geriatrics and the San Francisco Veterans Affairs Medical Center.
Laura Trupin is an epidemiologist in the Philip R. Lee Institute for Health Policy Studies at UCSF.
Maggie Rogers is senior research associate at the Center to Advance Palliative Care, in New York City.
Diane E. Meier is the director of the Center to Advance Palliative Care and a professor in the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, in New York City.
Tamara Dumanovsky is a vice president for research and analytics at the Center to Advance Palliative Care.


The predominant model for palliative care delivery, outside of hospice care, is the hospital-based consultative team. Although a majority of US hospitals offer palliative care services, there has been little research on the staffing of their program teams and whether those teams meet national guidelines, such as the Joint Commission's standard of including at least one physician, an advanced practice or other registered nurse, a social worker, and a chaplain. Data from the 2012-13 annual surveys of the National Palliative Care Registry indicate that only 25 percent of participating programs met that standard based on funded positions, and even when unfunded positions were included, only 39 percent of programs met the standard. Larger palliative care programs were more likely than smaller ones to include a funded physician position, while smaller programs were more reliant upon advanced practice and registered nurses. To meet current and future palliative care needs, expanded and enhanced education, as well as supportive financing mechanisms for consultations, are needed.


Elderly; Hospitals; Organization and Delivery of Care; Workforce Issues

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