We propose to build on the expertise of CIHI and the Dartmouth Atlas of Health Care to develop an initiative examining care delivery and measures of quality of care and EOL care in Canada and the US. Specifically, we wish to compare EOL care administered to all Americans and Canadians for which data exists, during a defined, contemporary period, by describing and comparing care delivered during the last year of life, last six months of life, and last month of life among US Medicare beneficiaries and Canadian Medicare beneficiaries. We plan to describe EOL care within each country; and in addition, we will make comparisons involving a number of variables, considering the following factors: time of comparison, decedent age range of comparison, the duration of time ante ceding death to compare (e.g. 2 years, 1 year, 6 months, 1 month and the time of death). We will also explore the above in relation to time-to-death.