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New Hampshire, Vermont Lead Nation in Access to Palliative Care

October 15, 2008

A new survey shows that despite being two of the most rural states in the United States, New Hampshire and Vermont are among the top states in the country when it comes to offering palliative care to their residents, a ranking that local palliative care providers say is recognition of the hard work that has gone into developing programs locally.

Palliative medicine is a comparatively new specialty in the U.S. that began to emerge in the late 1980s. It focuses on using a team approach to reduce the severity of disease symptoms for people living with a serious, often incurable disease. The goal of palliative care is to relieve suffering and improve the quality of life for people facing life-threatening illnesses by concentrating on a patient's physical, emotional and spiritual well being, as well as the well being of their families.

New Hampshire, Vermont and Montana were the only states to receive a grade of "A" on the state-by-state report card that was researched and presented by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC) using data from the Dartmouth Atlas of Health Care. It was published in the October 2008 issue of the Journal of Palliative Medicine.

"This ranking is a rewarding validation of the work that has been done to date and reflects a broader understanding nationally that palliative care is often highly valuable in the care of seriously ill patients and their families," said Dr. Ira Byock, M.D., Director of Palliative Medicine for Dartmouth-Hitchcock Medical Center (DHMC) who is a leading national expert in the field. "However, this report also reveals there is more work that needs to be done to improve access to palliative care in isolated rural areas of the country. Research is needed to develop effective and efficient ways to deliver palliative care to people when and where it is needed."

Part of that work for DHMC includes a collaborative effort with care providers in Littleton and Lancaster, NH, and St. Johnsbury, VT to strengthen and expand hospice and palliative care in rural areas. Through this North Country Palliative Care Collaboration (NCPCC), funded by a $100,000 grant by the Neil and Louise Tillotson Fund of the New Hampshire Charitable Foundation, DHMC's Section of Palliative Medicine is working with these regional providers to support local leadership and develop sustainable infrastructure for hospice and palliative care services for rural residents with advanced illness, and their families.

Another component of DHMC's leadership role is in palliative care research. A researcher and nurse practitioner on DHMC's Palliative Care Service, Marie Bakitas, DNSc, APRN is a recent grantee of the NPCRC. She stresses the importance of research in discovering the best ways to provide that care. Her research focuses on best ways to support people in making treatment decisions in the face of life-threatening illnesses. Bakitas is a co-investigator on Project ENABLE, a National Cancer Institute clinical trial that has shown real benefits to both the quality of life and survival of patients who receive palliative care during active cancer treatment. "When we started this study some naysayers thought that providing palliative care in conjunction with state-of-art cancer care would never catch on. Now have the evidence to show that this model of care measurably benefits our patients and families." Bakitas adds that other researchers have recently shown that this type of care may also reduce health care costs.

Byock said the new state-by-state report card showed encouraging trends nationally in the delivery of palliative care. In 2000, only a handful of hospitals in the U.S. provided palliative care services, which has grown to 52.8% today. Additionally, the study found that 84% of medical schools were associated with a hospital that has a palliative care program. Palliative care is now a board certified specialty for both doctors and nurses. Byock said this suggests that future doctors will graduate with a much better understanding of palliative care, and will be more likely to consider it as a treatment option for their patients who are dealing with life-threatening illnesses.

More information about the Palliative Care report card can be found at http://www.capc.org/reportcard.