Lead author Dr. David C. Goodman for the Dartmouth Atlas Project, which reports on trends and variation in end-of-life care, says end-of-life care differed substantially across regions and academic medical centers.
In 2007, the highest rates of death in a hospital were in the New York City area -- 45.8 percent in Manhattan -- while only 12 percent of the chronically-ill patients died in a hospital in Minot, N.D.; 10 percent in Fort Lauderdale, Fla. and 19.6 percent in Portland, Ore. The rate of chronically ill patients who died in University of Utah Health Care in Salt Lake City dropped from 31.5 percent to 21.3 percent.
The Dartmouth Atlas Project says chronically-ill Medicare patients spent fewer days in the hospital and received more hospice care in 2007 than they did in 2003. However, chronically ill Medicare patients had many more visits from physicians.
From 2003 to 2007, most academic medical centers changed the intensity of the end-of-life care they provided, but not all in the same direction -- some increased the intensity of care, while others provided less intensive care, the researchers say.
"In addition to its effects on patients' quality of life, unnecessarily aggressive care carries a high financial cost," Goodman says in a statement."About one-fourth of all Medicare spending goes to pay for the care of patients in their last year of life, and much of the growth in Medicare spending is the result of the high cost of treating chronic disease."