Researchers increasingly have sought to uncover the most significant factors fueling health disparities across the country. Recent data have dug into trends related to lagging hospice awareness, telehealth’s impacts on utilization, bereavement outcomes and the impact of state laws on palliative care.

Public Awareness Impedes Hospice Interest

A recent survey has found that significant knowledge gaps about hospice and palliative care exist among seniors in the United States, a trend dampening interest in receiving these services.

Many seniors are not aware of the full scope of options available for serious illness and end-of-life care, according to the National Poll on Healthy Aging from the University of Michigan’s (UM) Institute for Healthcare Policy & Innovation. The poll examined insights from seniors 50 and older across the state.

About 32% of the poll’s respondents knew very little or “not much” about hospice care, while 64% indicated that they did know about palliative care.

“We clearly have our work cut out for us to increase understanding of both these types of care, but especially palliative care,” Dr. Adam Douglass Marks, clinical associate professor at UM Health, told Cancer Health. “As more hospice providers offer care to people with more diagnoses at the end of life, it’s important for older adults to know it can be an option for them.”

The poll also examined interest in hospice and palliative care among senior populations in Michigan. A large portion, or 84% of respondents stated that they would be interested in receiving palliative care after learning more about these services, with 85% of the seniors expressing an interest in hospice care.

Disparities in awareness and understanding exist among the polled seniors. Older white and Asian American adults had nearly twice the likelihood of understanding palliative care compared to Black or Hispanic seniors, at 40% and 36% versus 21% and 22%, respectively. Additionally, 52% of Black and 53% of Asian American respondents were aware of hospice, compared to nearly three-fourths of white seniors polled.

9 Health Systems Examine Telehealth Utilization Patterns

Nine health systems have formed a collaborative to better understand how telehealth is being accessed and the potential impacts on utilization, clinical capacity and access to care.

The health systems are part of the American Telemedicine Association’s (ATA) Center of Digital Excellence (CODE). An analysis recently shared with Hospice News examined the operational telehealth utilization patterns across the new ATA CODE collaboration.

The analysis examined outcomes among 1.67 million Medicare beneficiaries in 30 states and Washington D.C. from 2019 to 2023. The health systems saw a combined 31.8x increase in telehealth visits during that time frame, while the average of overall patient visits among Medicare remained unchanged, the analysis found.

The findings suggest that virtual care growth has the potential to expand access, though regulatory roadblocks exist, according to Elissa Baker, project lead of the analysis and founder of ATA CODE.

“This data represents [the] current state under a patchwork policy environment,” Baker said in a statement shared with Hospice News. “We’re just scratching the surface of what health systems could achieve with predictable legislative frameworks that let us build infrastructure to serve patients regardless of who’s paying the bills.”

The health systems included Advocate Health Care, Ballad Health, Intermountain Health, Johns Hopkins Medicine, MedStar Health, Sanford Health, University of Pittsburgh Medical Center (UPMC), West Virginia University (WVU) Medicine and OSF OnCall, part of OSF HealthCare. Access TeleCare also contributed to the analysis.

The analysis examined Medicare fee-for-service claims, as well as data among Medicare Accountable Care Organization (ACO) programs and other payer data.

Among the key findings was that virtual care visits replaced in-person care at a substitution rate of 74% across the collaboration of health systems. This rate included avoiding patient referrals to tertiary and emergency care settings that in one instance resulted in a cost savings of roughly $8.1 million, the analysis found.

The analysis also found links between telehealth use and workforce sustainability. One health system reported saving about 42,000 clinical hours through virtual care monitoring, which helped to relieve staffing shortages and improve clinical capacity.

Bereaved Families Shed Light on Quality

Bereavement support is a key factor that family caregivers consider when evaluating the quality of end-of-life care.

This is according to a recent study published by the BioMed Central (BMC) Nursing journal. The study examined data collected among 318 bereaved family caregivers surveyed about their experiences from September 2019 through April 2021.

About 73.3% of the caregivers provided support to patients with a terminal illness who received some type of palliative or hospice care, the study found. Caregiver satisfaction with the family support provided was found to be at a “high level,” with a mean score of 15.47.

Significant factors in family satisfaction scores included provision of information received from end-of-life care providers related to pain and symptom management. Perceptions about quality of end-of-life care were also “significantly associated” with the grief experienced among family caregivers.

Bereaved family caregivers who perceived higher quality of end-of-life care reported lower levels of grief, the study found.

“Ensuring high-quality care, particularly towards the end of life, can significantly enhance the quality of dying and death (QODD) for terminally ill patients,” the researchers wrote. “This, in turn, may alleviate grief among their loved ones following their passing.”

Trends in State Palliative Care Laws

State health care policies impact the availability, sustainability and growth potential of palliative care delivery, recent research found.

Roughly 819 pieces of state legislation involving palliative care policies were introduced from 2009 to 2023, according to a recent study published in the Journal of the American Medical Association (JAMA) Health Forum.

The study spanned data from the Palliative Care Law and Policy GPS database developed in partnership with the Center to Advance Palliative Care (CAPC) and the Solomon Center for Health Law and Policy at Yale Law School.

Much of the state legislature that passed related to palliative care quality, standards and public awareness. Roughly 29.8% of the legislation was enacted, with passage rates declining as each bill repeated introduction, the study found.

Common themes in palliative care-related state legislation included improving public awareness, quality and standards, as well as payment policies, workforce issues and telehealth utilization, the study found. Massachusetts, New York and New Jersey saw the largest numbers of palliative care bills introduced, according to the study.

Stretching back more than a decade, a rising number of states have passed laws designed to raise awareness of hospice and palliative care, but to date, few if any have achieved measurable results.