Minnesota is becoming a Midwest leader in palliative medical care as more doctors, hospitals and patients warm up to what often is a confusing and misunderstood area of health care for people with advanced illness.

Some 89 percent of the state's medium and larger hospitals offer palliative care -- which focuses on easing pain and discomfort while often continuing aggressive treatment. That placed Minnesota among seven states getting an A in a report released Wednesday by the Center to Advance Palliative Care at Mount Sinai School of Medicine in New York City.

Minnesota ranked fifth among states in that category and 10th in a category covering smaller hospitals, with 37 percent of its smaller hospitals offering palliative care programs, the report said.

"We're doing a better job...but there still is so much to do," said Michele Fedderly, who heads the Minnesota Network of Hospice and Palliative Care.

Palliative care is getting a second look from many professionals and patients in the wake of some studies indicating that it can cut medical costs while helping patients live longer and better. At a time of tight scrutiny of soaring health care costs, policymakers are also considering ways to have Medicare cover palliative care as it does hospice care.

But progress will remain incremental until more patients -- and their doctors -- understand the difference between hospice care for the dying and palliative care for the very sick, Minnesota experts say.

"We have doctors who can't explain exactly what palliative care is," said Dr. Howard Epstein, medical director at Blue Cross and Blue Shield of Minnesota and board president of the Minnesota Network of Hospice and Palliative Care. "If they're confused, it's no surprise that many patients don't know much about palliative care."

Care of the soul

At Children's Hospital in Minneapolis, "we call it non-hospice palliative care" to help people know what we're not," said Jody Chrastek, who coordinates pain and palliative care.

"Palliative care is not about giving up. It's about making a patient's quality of life the best we can by controlling pain and discomfort -- by tending to the patient's body, mind, spirit and soul -- and maybe continuing aggressive medical care," she said.

Hospice includes the same approach to improving life, easing discomfort and helping the family, but for patients who are likely to die within six months.

A survey by the Hospice and Palliative Care Network earlier this year found that 68 percent of Minnesotans ages 50 to 80 did not know about palliative care, Fedderly said.

There are many efforts to change that.

• Palliative care certification: Regions Hospital in St. Paul became the seventh medical center in Minnesota to get an advanced care certification for its palliative care program from the Joint Commission, a national body that accredits hospitals. The national quality measure has been offered only since Sept. 1. More Minnesota hospitals are in the pipeline.

Rural hospice programs: The biggest gaps in palliative care are in the South and in rural areas, the report said.

Minnesota has become a leader. A collaboration between the Stratis Health of Bloomington and Fairview Health Systems has helped 16 rural communities develop hospice programs, with six to eight more likely next year.

"The push is coming from the communities. We had 35 applicants for the first 10 programs," said Karla Weng, a program manager at Stratis. "Small hospitals can't support palliative care alone, but when you combine them with home care, nursing homes, parish nurses and other providers, then you can make things happen."

• Education and training: Two of the eight national Palliative Care Leadership Centers are in Minnesota, at Fairview and at Children's Hospital, and have trained more than 160 palliative care teams.

"People come from all over to learn from Minnesota," Epstein said. "We're working very hard to develop and provide palliative care, and to train others how to do it."

In addition, clinical fellowships in palliative care and palliative social work are offered at University of Minnesota Medical Center, Mayo Clinic and Children's Hospital.

"We'll continue to expand this kind of care to more Minnesotans, however slowly," Fedderly said. "It's the kind of care you want, and it's the kind of care that doctors and nurses want to give."

To read the report, go to www.capc.org.

Warren Wolfe • 612-673-7253