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October 6, 2010

Critically Ill Patients and Long-term Acute Care Hospitals

JAMA. 2010;304(13):1441-1443. doi:10.1001/jama.2010.1400

To the Editor: Dr Kahn and colleagues1 asked valid research questions about the costs and benefits to Medicare beneficiaries who used long-term acute care hospitals following care in short-term acute care hospital intensive care units (ICUs). As with most health services research, it is necessary to avoid blurring the line between insights derived from the (necessarily dated) data and unanswered (necessarily current) policy questions. As the authors noted, Medicare beneficiaries make up about 70% of long-term acute care hospital patients. Excluded from the study were the increasing Medicare Advantage and commercial insurance populations, as well as the other two-thirds of Medicare fee-for-service long-term acute care hospital patients who did not use the short-term acute care hospital ICU. Consequently, the study population is less than one-quarter of all long-term acute care hospital patients, so any conclusions may not be generalizable.

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