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At the end of life, people with chronic diseases like cancer get more aggressive medical care in the New York area than anyplace else in the country, continuing a trend going back decades, according to a report released on Monday by researchers at Dartmouth College.

The study found that 46 percent of chronically ill patients in the Manhattan hospital region were being treated at hospitals when they died, as opposed to dying at home or in hospices or nursing homes. That rate was the highest in the country.
The region covering the New Brunswick, New Jersey region was fourth, at 39 percent. Nationally, 28 percent of hospitals’ chronic patients were being treated at hospitals when they died.

Dr. Elliott S. Fisher, a co-author of the new study, said that “[s]urveys show quite clearly that Americans don’t want to spend their last days in intensive-care units,” Dr. Fisher said. “What they want is to avoid suffering, to be with their families, to be mentally aware.”

His colleague Dr. David C. Goodman, a professor of pediatrics and health policy at Dartmouth Medical School, said that Medicare generally paid better for hospital-based care, including procedures and specialists, than for palliative care or community-based medical services.

The study also found that the use of hospice care was increasing in New York and across the country. Hospice care focuses on the quality of the life still remaining to the patient, rather than on curing diseases.

At the five academic medical centers in the New York City area, the average number of days patients spent in hospice care, either at home or in an institution, rose to 10.1 days in 2007 from 5.4 days in 2003.

“End-of-life care in the U.S. is changing fairly rapidly,” Dr. Goodman said Monday. Patients, he said, “are spending less time in the hospital and receiving more hospice care over all.”

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