When it comes to dying, people are better off in Oregon.

Two-thirds of Oregonians die at home compared with about half in Washington state and nearly 40 percent nationwide, according to findings published Wednesday.

People want to be in their home - not hooked up to machines in a hospital, said co-author Dr. Susan Tolle, head of the Center for Ethics at Oregon Health & Science University.

"Whenever anyone does a Gallup poll, a majority say they want to die at home," Tolle said. "Yet in much of the rest of the country that happens much less than in Oregon."

The findings, published in the New England Journal of Medicine, relied on Medicare statistics and defined "home" as wherever the person was living at the time of death.

They showed that Oregon has a relatively high rate of hospice use - 42 percent. That compares with 31 percent in Washington state and 17 percent in the rest of the country.

The study also found that Oregon tends to have less intrusive end-of-life care than elsewhere.

In the last month of life, for instance, 18 percent of Oregonians spend at least some time in intensive care units, compared with 23 percent in Washington and 29 percent in the rest of the country.

Though the research doesn't discuss the reasons behind the numbers, Oregon has long been a national leader in end-of-life care, physicians say, with providers emphasizing good palliative care - essentially controlling pain and making someone comfortable as they near death.

The state was the first in the nation to legalize assisted suicide two decades ago. But the most important, the study said, appears to be Oregon's creation of a POLST program in 1995. POLST, or physician orders for life-sustaining treatment, is a medical order that details end-of-life treatment according to a patient's wishes.

Jimmy Duty suffered a stroke in October 2015 when he died. His wife Pat says she was thankful he had filled out a POLST form which details end-of life wishes and is a medical order. POLST, or physicians orders for life-sustaining treatment, is filled out by patients with their doctors.

The form was a blessing for Pat Duty and her husband, Jimmy, who had a stroke in 2002 and recovered but then developed lung cancer in 2013. He beat that back but then dementia took hold. In 2014, he filled out a POLST form.

That process forced the family to discuss his end-of-life treatment.

"It takes the emotional burden off everyone," said Pat Duty, who lives in Beavercreek near Oregon City. "In a crisis situation like a heart attack, I wouldn't have to wonder what he wanted. I knew what he wanted."

Jimmy Duty died in October 2015 at the care center where he was living, his family around him.

More than 100,000 people have a POLST form in Oregon.

The study's other co-author, Dr. Joan Teno of the University of Washington, sees Oregon as a model in end-of-life care.

"We in Washington should learn from the experience in Oregon," Teno said in an email. "We need efforts aimed to improve care through education."

Tolle has championed POLST in Oregon and throughout the country. The Oregon program has a robust electronic registry of POLST forms. Medical centers and providers throughout the state can access it to check on a patient's wishes at the end of life. That helps ensure that they're met, Tolle said.

Washington has a POLST program and had a registry but scrapped it because it wasn't widely used, Tolle said.

"You can do these things but do them in a way that doesn't work as well," Tolle said.

Teno said if she were dying and comfort care were important, she would move to Oregon.

But the state still needs to do more work, the study says. For example, POLST forms still aren't uniformly part of a patient's medical record. That means that physicians in intensive care units might have to call the POLST registry to check on a patient's form.

Dying well requires that the system is aligned to respect a patient's wishes, Tolle said.

-- Lynne Terry

lterry@oregonian.com; 503-221-8503