The findings of the Dartmouth Atlas Project: a challenge to clinical and ethical excellence in end-of-life care.

The Dartmouth Institute for Health Policy and Clinical Practice Atlas Project found "staggering variations" in the quality and quantity of end-of-life care provided to Medicare patients with severe chronic illness across the United States. Particularly concerning is the finding that more care is provided to patients who live in "high-supply" areas, irrespective of the effectiveness of care, and that more care often equaled inappropriate care that increased patients' suffering at the end of life. Patients in "lower supply" areas typically received better, more appropriate levels of care and reported higher levels of satisfaction with the care they received.