Hospital Deaths By State….Best to Worst

Hospital Deaths….Defined

U.S. Value: : 20.8%

Healthiest State: Utah: 14.1%

Least-healthy State: New York: 29.8%

Definition: Percentage of deaths occurring in a hospital among chronically ill Medicare decedents aged 65 and older

Data Source & Year(s): The Dartmouth Atlas of Health Care, 2016

Suggested Citation: America’s Health Rankings analysis of The Dartmouth Atlas of Health Care, United Health Foundation, AmericasHealthRankings.org, Accessed 2019.

WHY DOES THIS MATTER?

Dying in the comfort of one’s own home is preferable for most seniors, with free standing hospice facilities as a second choice. Preferences are not always honored, however, and some seniors live their last few days of life in a hospital despite wishes for hospice or palliative care. Following patient preferences has improved over time. Since 2000, the proportion of deaths in hospitals has decreased.

End-of-life care in a hospital carries a high economic burden. Researchers estimate that among Medicare beneficiaries who died in 2014, average Medicare payments totaled nearly $35,000per person, with more than $17,000 going towards inpatient hospital costs. Following patient preferences can reduce Medicare spending and improve the quality of end-of-life care.

WHO IS AFFECTED?

Factors influencing whether end-of-life care is received in-hospital or out include:

  • Having a caregiver: Studies show patients without caregivers are more likely to die in an institution than patients with caregivers.
  • Availability of hospital resources: Areas with abundant health care resources (such as available hospital beds or medical specialists) tend to see greater use of hospital care and intensive care use among patients with chronic conditions, even when outpatient treatment would suffice.
  • Geographic region: The number of days spent in intensive care within the last six months of life varied by geographic region as well as hospital referral region, according to a 2016 Dartmouth Atlas Report. Other research shows urban areas with proximal hospital care reduces the likelihood that patient preferences are followed.

WHAT WORKS?

In many circumstances, dying in a hospital may be avoidable. Research shows family support, physician support and hospice enrollment improves alignment between preferred and actual place of death. Palliative care units in hospitals have been an effective strategy to reduce hospital costs and reduce the use of end-of-life intensive care treatments.

Advanced care planning is a valuable tool which allows older people to state their preferences for end-of-life care options, including wishes to die at home or in a hospice setting. The United States Department of Human Services offers resources to assist with Advanced Care Planning.

Hospital Deaths by State
STATE RANK VALUE
Utah 1 14.1%
Arizona 2 16.0%
Ohio 3 16.1%
Colorado 4 16.5%
Delaware 4 16.5%
Iowa 6 16.6%
Wisconsin 7 17.6%
Florida 8 17.7%
Idaho 9 17.8%
Georgia 10 18.0%
Rhode Island 11 18.2%
Arkansas 12 18.3%
Montana 13 18.4%
Kansas 14 18.6%
Texas 14 18.6%
Pennsylvania 16 18.7%
Michigan 17 18.8%
New Mexico 18 19.0%
South Dakota 19 19.3%
Indiana 20 19.4%
Louisiana 21 19.7%
Illinois 22 19.9%
Maine 22 19.9%
Wyoming 22 19.9%
North Carolina 25 20.2%
Oregon 25 20.2%
Nebraska 27 20.5%
New Hampshire 27 20.5%
South Carolina 27 20.5%
Minnesota 30 20.7%
West Virginia 31 20.9%
Mississippi 32 21.2%
Oklahoma 33 21.3%
Missouri 34 21.6%
Maryland 35 22.0%
Tennessee 36 22.2%
Alabama 37 22.7%
Virginia 37 22.7%
Kentucky 39 22.9%
Connecticut 40 23.0%
Washington 40 23.0%
Vermont 42 23.4%
Massachusetts 43 23.7%
Hawaii 44 24.1%
Nevada 45 24.2%
North Dakota 46 24.3%
California 47 25.3%
New Jersey 47 25.3%
Alaska 49 28.0%
New York 50 29.8%
United States 20.8%
District of Columbia 28.0%
 Data Unavailable
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