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Rural-Urban Differences in Medicare Service Use in the Last Six Months of Life

Care provided in the last year of life has garnered much attention over the past years. Concern has focused in two areas: patient preferences and costs associated with care during this time. With an increased emphasis on adhering to patient preferences, the use of intensive hospital or medical care in the last months of life has decreased, whereas the use of hospice and palliative care has increased. Previous research has found wide variations in service utilization during the last six to twelve months of life. The Dartmouth Atlas Project has published several studies documenting regional variations in hospitalizations, hospital days, intensive care use, hospice use and high-intensity services during this time. Variations may be associated with resource availability; for example, some studies indicate that living farther from a hospital reduces hospitalizations in the last year of life, whereas others have shown an association between hospital type and service intensity. Other variations in use of end of life care are associated with patient characteristics, with non-white individuals being less likely to seek hospice or palliative care and more likely to have hospitalizations or other intensive services during this time. Some of these variations can be attributed to differences in personal preferences, as research suggests that non-white patients typically do not prefer hospice or palliative care.