Hillcrest Medical Center has become the first hospital in Oklahoma and the 12th in the nation to be certified in palliative care with The Joint Commission as it and other healthcare organizations focus more on long-term care and symptom management. The palliative care program at Hillcrest started in June 2011 and includes three doctors and two nurse practitioners. A 2011 report from the Center to Advance Palliative Care and the National Palliative Care Research Center gave Oklahoma a grade of D in palliative care. About 30 percent of the state's hospitals have a palliative care program, compared to 50 percent of hospitals in the region and more than 60 percent in the nation, according to the report.