• Joan M Teno, Vincent Mor, Nicholas Ward, Jason Roy, Brian Clarridge, John E Wennberg, and Elliott S Fisher.
• Center for Gerontology and Health Care Research, Brown Medical School, Providence, Rhode Island 02912, USA. Joan_Teno@Brown.edu
• J Am Geriatr Soc. 2005 Nov 1;53(11):1905-11.

ObjectivesTo compare the quality of end-of-life care of persons dying in regions of differing practice intensity.DesignMortality follow-back survey.SettingGeographic regions in the highest and lowest deciles of intensive care unit (ICU) use.ParticipantsBereaved family member or other knowledgeable informants.MeasurementsUnmet needs, concerns, and rating of quality of end-of-life care in five domains (physical comfort and emotional support of the decedent, shared decision-making, treatment of the dying person with respect, providing information and emotional support to family members).ResultsDecedents in high- (n=365) and low-intensity (n=413) hospital service areas (HSAs) did not differ in age, sex, education, marital status, leading causes of death, or the degree to which death was expected, but those in the high-intensity ICU HSAs were more likely to be black and to live in nonrural areas. Respondents in high-intensity HSAs were more likely to report that care was of lower quality in each domain, and these differences were statistically significant in three of five domains. Respondents from high-intensity HSAs were more likely to report inadequate emotional support for the decedent (relative risk (RR)=1.2, 95% confidence interval (CI)=1.0-1.4), concerns with shared decision-making (RR=1.8, 95% CI=1.0-2.9), inadequate information about what to expect (RR=1.5, 95% CI=1.3-1.8), and failure to treat the decedent with respect (RR=1.4, 95% CI=1.0-1.9). Overall ratings of the quality of end-of-life care were also significantly lower in high-intensity HSAs.ConclusionDying in regions with a higher use of ICU care is not associated with improved perceptions of quality of end-of-life care.

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