This article examines geographic variance in patient and medical trainee access to palliative care.
- Factors significantly associated with hospital palliative care include geographic location, owning a hospice program, having an American College of Surgery approved cancer program, percent of persons in the county with a university education, and medical school affiliation.
- For-profit and public hospitals were significantly less likely to have hospital palliative care when compared with nonprofit institutions.
- States with higher hospital palliative care penetration rates were observed to have fewer Medicare hospital deaths, fewer intensive care unit/cardiac care unit (ICU/CCU) days and admissions during the last 6 months of life, fewer ICU/CCU admissions during terminal hospitalizations, and lower overall Medicare spending/enrollee.
- Overall, medical students have high rates of access to hospital palliative care although complete penetration into academic settings has not occurred.