How End-of-Life Care Varies Depending on Where You Live
Carla Keirns
Project funded by the Robert Wood Johnson Foundation
Research Program

Americans facing serious illness receive different care, at different cost, and with different outcomes based on where they live. Since the 1970s researchers from a number of groups, most notably John Wennberg, Elliott Fisher and David Goodman at the Dartmouth Institute for Health Policy & Clinical Practice, have made a compelling case that the use of medical services and procedures varies widely from community to community for reasons not fully accountable by medical need, not clearly related to evidence or medical outcomes, and likely substantially influenced by supply.

Carla C. Keirns, MD, PhD, assistant professor of preventive medicine, medicine and history at Stony Brook University, will examine Regional Variations in End of Life Care and Costs: Cultures of Medicine or Structures of Caregiving? for her Investigator Award project. The questions that the project will address include, how do individuals and families navigate health care,? what are the sources of regional variation in end-of-life care,? what are the costs, structures and cultures of medical practice regionally,? and how do patterns of housing, employment, and family structure affect the choices available to patients at the end of lifeó particularly the feasibility of home hospice care? Drawing on her experience as a practicing palliative-care physician, sociologist, health services researcher, and historian, Dr. Keirns will use health utilization data, interviews and community studies to make sense of individual choices and regional patterns that are fundamental to understanding how to empower patients, improve care and reduce costs.