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Letters
October 6, 2010

Critically Ill Patients and Long-term Acute Care Hospitals—Reply

JAMA. 2010;304(13):1441-1443. doi:10.1001/jama.2010.1401

In Reply: Our study examined temporal changes in long-term acute care hospital utilization after critical illness in the Medicare population. We found that long-term acute care hospital use is increasing over time, with a concomitant increase in related costs, calling attention to the increasingly important role these hospitals play in the US health care system.

Drs Votto and Hotes and Dr Muldoon correctly state that our study cannot be used to infer whether care in a long-term acute care hospital is beneficial or harmful compared with an alternative site of care. As we stated in our discussion, there are plausible reasons why long-term acute care hospitals might either improve or worsen outcomes after critical illness. The studies quoted by Votto and Hotes, as well as others,1 provide important preliminary evidence but do not offer definitive conclusions. Rigorous comparative effectiveness research is needed to determine not only which patients may benefit from the services long-term acute care hospitals provide, but also the optimal site of care for these services.

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