Access to Palliative Care in Rural Wisconsin
DeAnn Richards, RN, BSN, CIC
Environmental Scan Shows Current Capacity
Palliative care is supportive medical care—at any age, diagnosis, or stage of illness—focusing on providing patients with relief from the symptoms, pain, and stress of a serious illness to improve quality of life.¹ America’s Care of Serious Illness 2015 State-By-State Report Card on Access to Palliative Care in Our Nation’s Hospitals demonstrated the importance of palliative care. This report highlighted the need for each state to “create a multidisciplinary advisory board and/or task force to conduct a landscape analysis of available palliative care services to determine state capacity and develop appropriate recommendations for improving access to quality palliative care.”² Recent Wisconsin Senate and Assembly bills³,⁴ failed to pass pursuant to Senate Joint Resolution 1 in March 2018. As a result, an environmental scan was the best option to fulfill the desired state from the report, which indicated “conducting a needs assessment and gap analysis is the foundation for strengthening access to palliative care at the state level.”² MetaStar, under contract with the Wisconsin Office of Rural Health, conducted the environmental scan by looking at the population and the providers of this service.
One of the most significant findings of the environmental scan focused on rural counties. The 2017 Rural Wisconsin Health Report identified 46 of 72 counties (65%) as rural. Northern Region counties have the highest percentage of rural counties (93%) while Southeastern Region the lowest (25%). However, only 26% of the Wisconsin population resides within a rural county. In addition to potential geographic spread issues, certain conditions were more prevalent in rural counties. Coronary heart disease hospitalizations were reported as 3.5 per 1,000 people in a rural setting, which was higher than urban (2.6) and the state as a whole.⁵ Ten percent of rural adult residents were reported diabetic, which was higher than urban and state (9%). Preventable hospital stays were 47 per 1,000 Medicare enrollees in the rural setting compared to urban (44) and state (45). Other aspects of rural health were consistent with urban and state, including the percent of rural adult residents reporting frequent physical or mental distress (10%), the percent who didn’t receive needed health care (2%), and the percent living below the Federal Poverty Line (12%).⁶
When considering providers for care in rural areas, it was noted that 21 acute care hospitals⁶ are located in rural counties. Also, 43 critical access hospitals⁷ are in rural counties. Eighty-one hospice organizations are in the state.⁸ Surveyed hospitals and members of the Palliative Care Network of Wisconsin indicated the presence of 33 palliative care organizations in Wisconsin. The only county without a known palliative care organization is Pepin, which lies in the Western region along the border with Minnesota.
As MetaStar continues to work with the Wisconsin Office of Rural Health, next steps will include determining the challenges of providing palliative care in a rural setting and addressing needs through collaborative efforts with providers and stakeholders. Interdisciplinary palliative care services are a cornerstone for addressing the needs of patients with serious illness and high health care costs as well as providing the highest quality of life for them and their families.⁹
DeAnn Richards, RN, BSN, CIC, is a project specialist at MetaStar, Madison, Wis.
2. Center to Advance Palliative Care and the National Palliative Care Research Center. America’s care of serious illness: 2015 state-by-state report card on access to palliative care in our nation’s hospitals. Accessed September 6, 2018.
3. Wisconsin 2017 Senate Bill 548. Accessed September 6, 2018.
4. Wisconsin 2017 Assembly Bill 633. Accessed September 6, 2018.
5. Wisconsin Office of Rural Health. Rural Wisconsin health. Accessed September 6, 2018.
6. Department of Health Services Division of Quality Assurance. Hospitals provider directory for Wisconsin. Published September 28, 2018. Accessed June 2, 2018.
7. Wisconsin Critical Access Hospital Effective Date Index. Updated May 15, 2018. Accessed June 2, 2018.
8. Department of Health Services Division of Quality Assurance. Hospice & branches/residential facilities (RF) provider directory with branches, counties & services. Updated December 28, 2018. Accessed June 2, 2018.
9. Li YR, Anderson E, Ingelson B, Noorizadeh K. Interdisciplinary palliative care services for cancer patients: assessing quality of care and outcomes measures of successful intervention. J Clin Oncol. 2017; Suppl 127. JCO.2017.35.31_suppl.127. Accessed June 2, 2018.