Hospital provision of end-of-life services: Who, what, and where?

BACKGROUND: Availability of options other than aggressive medical treatment for persons with life-limiting illnesses has provided hospitals an opportunity to adopt formalized end-of-life care services. OBJECTIVE: To describe hospital ownership types that have adopted formalized end-of-life services (who), the scope of end-of-life services offered (what), and the geographic location of service provision (where). RESEARCH DESIGN: Nationally representative cross-sectional data for 3,939 hospitals (80% of respondent hospitals) obtained from the American Hospital Association Annual Survey of Hospitals was used for the year 1998. MEASURES: A scale was developed to measure hospital provision of general end-of-life, pain management, or hospice services. A multivariate ordinary least-squares regression model was used to test the association of ownership as a predictor of end-of-life service provision, while controlling for internal (organizational) and external (market location and size) characteristics. RESULTS: Independent correlates of the number of end-of-life services provided include Catholic ownership, teaching status, number of staffed beds, and being located in a metropolitan statistical area or in New England. Forty-four percent of the sampled US hospitals provide none of the three end-of-life services included in this study. Another one third of hospitals provide only one of the three services. CONCLUSIONS: Given the attention paid by both the general public and health professionals to pain relief and providing appropriate care to dying persons, such services are slow to be institutionalized in the hospital setting. The authors' findings suggest strategies for research and policy.