title: Predictors of Hospital Length of Stay and Readmissions in Ischemic Stroke Patients and the Impact of Inpatient Medication Management.
abstract: OBJECTIVE
  This study was designed to evaluate predictors of hospital length of stay (LOS) and readmissions among nonsurgical ischemic stroke patient, and the impact of inpatient medication management.
  
  
  METHODS
  This retrospective cohort study includes adult patients (≥18 years) hospitalized with a diagnosis of nonsurgical ischemic stroke from November 2007 to March 2013. In November 2011, an inpatient medication management model was implemented in the stroke unit. At the end of the study period, patients were matched before and after implementation of the inpatient medication management model (non-PHC [pharmacist-hospitalist collaborative] and PHC, respectively) to evaluate change in outcomes. The primary outcome of the study is an evaluation of predictive factors affecting LOS and readmissions. Additionally, changes in LOS and all-cause readmission at 30, 60, and 90 days when compared between PHC and non-PHC were evaluated.
  
  
  RESULTS
  A total of 151 PHC patients were matched to 248 non-PHC patients. There was no difference in LOS between the PHC and non-PHC patients (mean adjusted difference -.14; P = .66). Similar finding was observed for readmissions (P > .05). Insurance type was a significant predictor of LOS, with Medicare patients having an extended LOS compared to patients with private insurance (mean difference -1.00; P = .005). Patients taking statins and patients aged less than 80 years had a lower 30-day readmission rate compared to nonstatin users and patients aged 80 years or older, respectively (P < .05).
  
  
  CONCLUSIONS
  Insurance type and severity of illness are important predictors of LOS, whereas readmissions are mostly influenced by age and statin use.
authors.affiliation: College of Pharmacy Florida A&M University, Tallahassee Florida. Electronic address: preseoapc@msn.com.
authors.forename: Arinze Nkemdirim
authors.initials: AN
authors.lastname: Okere
authors.affiliation: Essentia Health, Essentia Institute of Rural Health, Duluth, Minnesota.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Renier
authors.affiliation: Neuroscience Unit, Spectrum Health, Butterworth Hospital, Grand Rapids, Michigan.
authors.forename: Angela
authors.initials: A
authors.lastname: Frye
mesh_terms: D002545:Brain Ischemia / Q000150:complications; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Inpatient medication therapy management; ischemic stroke; medication reconciliation; model of care; stroke