The Serious Illness Scorecard: Rating the States Across Key Capabilities

{"title":"The Serious Illness Scorecard: Rating the States Across Key Capabilities","authors":"Allison Silvers MBA,&nbsp;Stacie Sinclair MPP,&nbsp;Rachael Heitner MPH MA,&nbsp;Allison Silvers MBA","doi":"10.1016/j.jpainsymman.2025.02.040","DOIUrl":null,"url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Participants will compare and contrast state-based infrastructure that supports access to high-quality palliative care.</div><div>2. Participants will devise a strategy to improve care for the population with serious illness in their own institution and/or state.</div></div><div><h3>Key Message</h3><div>The Serious Illness Scorecard uses an expansive methodology to rate U.S. states in care for families facing serious illness. Out of a possible five stars, nine states scored 4.0 or higher, while six scored 1.5 or below. Palliative care champions can leverage this resource to address disparities in access.</div></div><div><h3>Abstract</h3><div>While palliative care has grown tremendously in recent years, parts of the U.S. still lag in access and other best practices. Previous “America's Care of Serious Illness: State-by-State Report Cards” have tracked growth using the number of hospital programs. (1) Our new “Serious Illness Scorecard” better reflects the expansion of the field by scoring states across five domains and ten metrics.</div></div><div><h3>Objective</h3><div>To provide a comprehensive assessment of state readiness to deliver high-quality care during serious illness.</div></div><div><h3>Methods</h3><div>We collected data on ten variables across 50 states and DC, measuring: hospital program availability; certified specialists per 100,000 population; state policy mandating palliative care payment (2); relevant medical or nursing board education requirements; pediatric and adult long-term care capabilities (3); and other features. These data were combined to produce a rating out of five stars.</div></div><div><h3>Results</h3><div>Two states (Oregon and Massachusetts) earned 4.5 stars, 23 states scored above three (3) stars, six states scored under 1.5 stars, and two (Arkansas and Wyoming) earned only 1 star. Hospitals (&gt;50 beds) with palliative care range from 45.5% (Arkansas) to 100% in six states. Home-based programs are reported in 79% of US counties. With a national median of 5.1 palliative care certified specialists per 100,000 population, states range from 2.24 (Oklahoma) to 12.62 (Rhode Island). Thirteen states have some form of palliative care payment policy, and 21 states require all licensed physicians and/or nurses to complete training in relevant skills.</div></div><div><h3>Conclusion</h3><div>U.S. states vary widely in their support of palliative care and their capacity to meet the needs of people with serious illness but, overall, states are skewing to higher capacity.</div></div><div><h3>References</h3><div>1. America's Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation's Hospitals. Center to Advance Palliative Care and the National Palliative Care Research Center. September 2019 2. Bowman BA, Twohig JS, Meier DE. Overcoming Barriers to Growth in Home-Based Palliative Care. J Palliat Med. 2019 Apr;22(4):408-412. 3. Cheng Z, Mutoniwase E, Cai X, Li Y. Higher levels of state funding for Home- and Community-Based Services linked to better state performances in Long-Term Services and Supports. Health Serv Res. 2024 Apr;59(2):e14288. doi: 10.1111/1475-6773.14288.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e431-e432"},"PeriodicalIF":3.2000,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pain and symptom management","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0885392425001009","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}