Among the nation's 306 hospital referral regions, 2,400 hospitals, and among all states, practice patterns show wide variation in this index. For example, hospitals in New Jersey, New York, Florida, California, and Nevada had the highest end-of-life intensity scores: Hospitals in Utah, Idaho, Oregon, Montana, and Vermont had the lowest.
In 2007, New Jersey, New York, Nevada, Delaware and California were the highest utilizers of intensive end-of-life care, while Idaho, Utah, Oregon, Montana and Vermont were the lowest.
Variations extend to specific cities and towns. Hospitals in Los Angeles in 2010 had the highest intensity index, followed by Miami, Manhattan, and McAllen, TX. And Medicare's costs for those patients were correspondingly higher than other metropolitan regions or towns, ranging from $112,263 to $109,557 for these four cities.
On the other hand, Minot, ND; Bismarck, ND; La Crosse, WI; and Dubuque, IA had the lowest cost of care and among the lowest hospital intensity scores. Medicare spent on average between $47,620 and $46,563 per patient in those areas.
A separate section of the Dartmouth update analyzes changes in end-of-life service delivery among the nation's academic medical centers. The report said that while "striking variation" has been noted among these teaching hospitals, "but that care is changing quickly in many centers.