Yong-Fang Kuo, PhD; James S. Goodwin, MD
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0086.
Kuo Y., Goodwin J.; Hospital Care and Medical Utilization After Discharge. Ann Intern Med. 2011;155:722. doi: 10.7326/0003-4819-155-10-201111150-00023
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Published: Ann Intern Med. 2011;155(10):722.
We thank the correspondents for their interest in our paper. Dr. Mitchell and Drs. Meltzer and Chung note potential issues with internal and external validity in our observational study. We agree that assessing long-term outcomes could be a way to indirectly examine the presence of selection bias, and we have used that method in other studies (1). In this study, we controlled for medical utilization and costs in the year before the index hospitalization. We also included instrumental variable analyses in earlier versions of the paper but deleted them in favor of conditional models with the nonpooling approach of propensity analysis in response to the statistical reviewer's suggestion.
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