This finding supports the trend observed for higher specialty hospital efficiency with regard to patient charges and LOS. Comparing quality measures between specialty hospitals and small general hospitals of similar size, readmission within 30 days of discharge was 20% lower (OR=0.796) selleck chemicals llc in spine specialty hospitals but was similar to larger hospitals (mid-sized, tertiary hospitals). This quality measure might be better in spine specialty hospitals because of their higher patient volume and much vaster medical experience in the area of spine disease. However, we did not find any association

with mortality within 30 days of admission to spine specialty hospitals. We would expect very few cases of mortality among all types of hospitals since spine disease procedures typically are not life-threatening. Of note, our study was only able to evaluate in-hospital mortality, which might underestimate actual mortality cases. This study has several limitations worth considering; therefore, the results must be interpreted with caution. The potential limitation of our study involves our measurement of the effect of ‘specialty’ designation status. Because of the relatively recent establishment of the specialty hospital designation system (1

November 2011), there has not been sufficient time to thoroughly investigate the effects of the ‘specialty’ designation on hospital operating efficiency. Additional studies using more robust data sets should be performed to better inform long-term policy on spine specialty hospitals. Furthermore, this study may not fully adjust case-mix adjustment, although the analysis models include current diagnosis and procedure code, due to the nature of claims data. In addition, we did not have access to information about non-NHI covered procedures, which is important because non-covered services are typical in spine-related procedures. Our study also lacked patient satisfaction records or socioeconomic status data that may have affected the results of our study.26 The other limitation was the inability to analyse hospital financial performance. Because we did not include

institutions’ financial statements or costs, it was not possible to examine the real financial viability of hospitals. Therefore, the actual revenue, costs, profit and financial viability and their possible impact on our results remain unknown. Although our study Anacetrapib involved only spine-related inpatient claim data, it represents, to the best of our knowledge, one of only a few studies to evaluate the performance and characteristics of specialty hospitals in this country and outside the USA as well. Our conclusions add to the mounting evidence about the greater efficiency and cost benefits of specialty hospitals; these results contribute to the reasoning for designing ‘specialty’ designation requirements and implementing specialty hospital systems in a health policy perspective.