Policy and Politics to Drive Change in End-of-Life Care: Assessing the Best and Worst Places to Die in America

The United States spends $3.4 trillion annually on healthcare, but outcomes are suboptimal, and almost a third of the care is inappropriate or unnecessary. A small percentage of patients accounts for a disproportionate amount of spending. Dartmouth Atlas of Healthcare data show serious gaps in the quality of advanced illness and end-of-life care delivery, allowing us to rank best and worst places to die. Such statistics are important for legislative and regulatory changes aiming to address disparities and ensure person-centered care delivery. Implementing initiatives requires a community of stakeholders committed to improving care in advanced illness, as well as culture change.