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Final care depends on where you live

How much medical care you receive in your dying days may depend a lot on where you live.

Retirees in Sun City, Ariz., take part in health education programs that teach everything from the horrors of Alzheimer's disease to how to prepare a "Do Not Resuscitate" order.They're prepared more for a quiet death, not one full of heroic medical attempts, says one doctor. And a new study bears him out: Sun City retirees spend just half a day in intensive care on average before they die - while old people in Miami average almost five days in ICU.

With such a gap, which city is treating the dying properly? The Dartmouth Atlas of Health, which found vast geographic disparities in end-of-life care around the country, could not say.

"In order to die, do I need to be in a hospital with a catheter, the IV on and fully tubed? No," said Dr. Walter Nieri of the Sun Health-St. Joseph's Geriatric Fellowship Program.

"The truth is probably in the middle," said Dr. Beth Virnig of the University of Miami.

But other doctors said the report should force communities to compare themselves with their neighbors - and decide whether they need to adjust treatment standards.

"Take a minute to think about (whether) you're practicing the same as everybody or different from everybody," said Georgetown University's Dr. Kevin Schulman. "We need to look at these differences, which are in favor of patient care and which are hurting patients."

Dartmouth Medical School epidemiologist Dr. John Wennberg, who first uncovered regional variations in medicine in the 1980s, mapped the distribution of health care resources in 1994-95 - the latest data available - and how people in 306 hospital "referral regions" used them.

The study, being released Wednesday, confirms earlier surgical disparities - that, for example, patients in some states get heart bypass surgery or mastectomies for breast cancer more often than less-invasive alternatives.

Wennberg now has discovered stark differences in one of medicine's most difficult areas: how to care for the dying.

The atlas found that dying Medicare patients were hospitalized longest in Newark, N.J., 22.9 days, and New York City's Manhattan, 22 days. The longest hospital stays were in the Northeast and Deep South, while the West had the shortest, including 4.4 days in Ogden, Utah, and 5.3 days in Salt Lake City.