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. Author manuscript; available in PMC: 2012 Apr 21.
Published in final edited form as: JAMA. 2011 Oct 5;306(13):1447–1453. doi: 10.1001/jama.2011.1410

Figure 1.

Figure 1

Geographic Variation in Advance Directivesa,b

aUnadjusted proportion of decedents with written advance directives across hospital referral regions in the United States. 3,302 Health and Retirement Study decedents dying between 1998 and 2007; 454 lived in low-spending regions, 1,847 in medium-spending regions, 1,001 in high-spending regions. Spending levels for Regions are based on average per-decedent Medicare spending in the last 6 months life reported by the Dartmouth Atlas of Health Care for 1999 –2005, not on the particular decedents in the present study.31

bAny Advance Directive includes those with a Living Will or a Durable Power of Attorney for Healthcare (DPOA). Treatment-Limiting Directive includes those with a Living Will that specifies “a desire to limit care in certain situations.”