Kellie L. Flood

University of Alabama at Birmingham

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Cynthia J. Brown

Louisiana State University Health Sciences Center New Orleans

Jasmine Vickers

University of Alabama at Birmingham

Richard Kennedy

University of Alabama at Birmingham

Katrina Booth

University of Alabama at Birmingham

Maria Carroll

Washington University in St. Louis

David B. Carr

Washington University in St. Louis

Emily Simmons

Lurie Children's Hospital

Cyndi V. Le

Barnes-Jewish Hospital

Julie L. Locher

University of Alabama at Birmingham

Tobias O’Leary

University of Alabama at Birmingham

Cooperative Institutions

University of Alabama at Birmingham

University of the Basque Country

Campbell Collaboration

University of Cincinnati

Chonnam National University

University of Bonn

Duke University

Korea Institute of Science & Technology Information

High Energy Accelerator Research Organization

University of Florida

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Acute Care for Elders

Springer eBooks (2024)

Kellie L. Flood Ellen S Danto-Nocton C. -H. Kim Katrina Booth Denise Kresevic

10.1007/978-3-031-56204-4_1

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Polypharmacy in hospitalized older adult cancer patients: Experience from a prospective, observational study of an Oncology-Acute care for elders unit

The American journal of geriatric pharmacotherapy (2009)

Kellie L. Flood Maria Carroll Cyndi V. Le Cynthia J. Brown

Geriatric oncology

Regimen

10.1016/j.amjopharm.2009.05.002

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Citations (82)

An Implementation Assessment of the Virtual Acute Care for Elders Program From the Perspective of Key Stakeholders

Annals of Surgery (2020)

Courtney J. Balentine Melanie S. Morris Sara J. Knight Janet M. Turan Kellie L. Flood

Objective: The aim of this study was to obtain feedback from key stakeholders and end users to identify program strengths and weaknesses to plan for wider dissemination and implementation of the Virtual Acute Care for Elders (Virtual ACE) program, a novel intervention that improves outcomes for older surgical patients. Background: Virtual ACE was developed to deliver evidence-based geriatric care without requiring daily presence of a geriatrician. Previous work demonstrated that Virtual ACE increased mobility and decreased delirium rates for surgical patients. Methods: We conducted semi-structured interviews with 30 key stakeholders (physicians, nurses, hospital leadership, nurse managers, information technology staff, and physical/occupational therapists) involved in the implementation and use of the program. Results: Our stakeholders indicated that Virtual ACE was extremely empowering for bedside nurses. The program helped nurses identify older patients who were at risk for a difficult postoperative recovery. Virtual ACE also gave them skills to manage complex older patients and more effectively communicate their needs to surgeons and other providers. Nurse managers felt that Virtual ACE helped them allocate limited resources and plan their unit staffing assignments to better manage the needs of older patients. The main criticism was that the Virtual ACE Tracker that displayed patient status was difficult to interpret and could be improved by a better design interface. Stakeholders also felt that program training needed to be improved to accommodate staff turnover. Conclusions: Although respondents identified areas for improvement, our stakeholders felt that Virtual ACE empowered them and provided effective tools to improve outcomes for older surgical patients.

Staffing

Acute care

Needs assessment

10.1097/sla.0000000000004433

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Measurements of branching fractions and asymmetry parameters of $$ {\Xi}_c^0\to \Lambda {\overline{K}}^{\ast 0} $$, $$ {\Xi}_c^0\to {\Sigma}^0{\overline{K}}^{\ast 0} $$, and $$ {\Xi}_c^0\to {\Sigma}^{+}{K}^{\ast -} $$ decays at Belle

Journal of High Energy Physics (2021)

S. Jia S. S. Tang C. P. Shen I. Adachi H. Aihara

Using a data sample of 980 fb$^{-1}$ collected with the Belle detector at the KEKB asymmetric-energy $e^+e^-$ collider, we study the processes of $\Xi^0_c\to \Lambda\bar K^{*0}$, $\Xi^0_c\to \Sigma^0\bar K^{*0}$, and $\Xi^0_c\to \Sigma^+K^{*-}$ for the first time. The relative branching ratios to the normalization mode of $\Xi^0_c\to\Xi^-\pi^+$ are measured to be $${\cal B}(\Xi^0_c\to \Lambda\bar K^{*0})/{\cal B}(\xic\to \Xi^-\pi^+)=0.18\pm0.02({\rm stat.})\pm0.01({\rm syst.}),$$ $${\cal B}(\Xi^0_c\to \Sigma^0\bar K^{*0})/{\cal B}(\xic\to \Xi^-\pi^+)=0.69\pm0.03({\rm stat.})\pm0.03({\rm syst.}),$$ $${\cal B}(\Xi^0_c\to \Sigma^+K^{*-})/{\cal B}(\xic\to \Xi^-\pi^+)=0.34\pm0.06({\rm stat.})\pm0.02({\rm syst.}),$$ where the uncertainties are statistical and systematic, respectively. We obtain %measure the branching fractions of $\Xi^0_c\to \Lambda\bar K^{*0}$, $\Xi^0_c\to \Sigma^0\bar K^{*0}$, and $\Xi^0_c\to \Sigma^+K^{*-}$ to be $${\cal B}(\Xi^0_c\to \Lambda\bar K^{*0})=(3.3\pm0.3({\rm stat.})\pm0.2({\rm syst.})\pm1.0({\rm ref.}))\times10^{-3},$$ $${\cal B}(\Xi^0_c\to \Sigma^0\bar K^{*0})=(12.4\pm0.5({\rm stat.})\pm0.5({\rm syst.})\pm3.6({\rm ref.}))\times10^{-3},$$ $${\cal B}(\Xi^0_c\to \Sigma^+K^{*-})=(6.1\pm1.0({\rm stat.})\pm0.4({\rm syst.})\pm1.8({\rm ref.}))\times10^{-3},$$ where the uncertainties are statistical, systematic, and from ${\cal B}(\xic \to \Xi^-\pi^+)$, respectively. The asymmetry parameters $\alpha(\Xi^0_c\to \Lambda\bar K^{*0})$ and $\alpha(\Xi^0_c\to \Sigma^+K^{*-})$ are $0.15\pm0.22({\rm stat.})\pm0.04({\rm syst.})$ and $-0.52\pm0.30({\rm stat.})\pm0.02({\rm syst.})$, respectively, where the uncertainties are statistical followed by systematic.

10.1007/jhep06(2021)160

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The current landscape of Acute Care for Elders units in the United States

Journal of the American Geriatrics Society (2022)

Stephanie Rogers Kellie L. Flood Qiao Yu Kuang James D. Harrison Michael L. Malone

The clinical benefits of Acute Care for Elders (ACE) units have been established for over 25 years. However, how widely disseminated ACE units are in the United States and the degree of fidelity to the key elements of this model of care are unknown. Our objective was to identify all existing ACE units in the United States and to obtain detailed information about variations in implementation.The strategy to identify current ACE units began with online searches and snowball sampling using contacts from professional societies and workgroups. Next, a request for information regarding the existence of ACE units was sent to the remaining US hospitals listed in a national hospital database. An online survey was sent to identified ACE unit contacts to capture information on implementation characteristics and the five key elements of ACE units.There were 3692 hospitals in the database with responses from 2055 (56%) hospitals reporting the presence or absence of an ACE unit. We identified 68 hospitals (3.3%) with an existing or previous ACE unit. Of these 68 hospitals, 50 (74%) completed the survey and reported that 43 ACE units were currently open and 7 had been closed. Of the 43 currently open ACE units, most are affiliated with an academic hospital and there is variable implementation of each of the five key ACE elements (from 69% to 98%).Among the 50 hospitals to complete the survey, 43 current ACE units were identified, with variable fidelity to the key elements. Estimates of prevalence of ACE units and fidelity to key elements are limited by nonresponses to the national survey request by nearly half of hospitals.

Snowball sampling

Acute care

10.1111/jgs.17892

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The Association Between Life-Space and Health Care Utilization in Older Adults with Heart Failure

The Journals of Gerontology Series A (2015)

Alexander X. Lo Kellie L. Flood Richard Kennedy Vera Bittner Patricia Sawyer

Life-space is associated with adverse health outcomes in older adults, but its role in health care utilization among individuals with heart failure is not well understood. We examined the relationship between life-space and both emergency department (ED) utilization and hospitalization.Participants were community-dwelling older adults with a verified diagnosis of heart failure who completed a baseline in-home assessment and at least one follow-up telephone interview. Life-space was measured at baseline and at follow-up every 6 months for 8.5 years. Poisson models were used to determine the association between life-space, measured at the beginning of each 6-month interval, and health care utilization, defined as ED utilization or hospitalization in the immediate ensuing 6 months, adjusting for sociodemographic and clinical confounders.A total of 147 participants contributed 259 total health care utilization events involving an ED visit or a hospital admission. Multivariate analysis demonstrated an inverse association between life-space and health care utilization, where a clinically significant 10-point difference in life-space was independently associated with a 14% higher rate of ED utilization or hospitalization (incidence rate ratio 1.14, 95% CI 1.04-1.26, p = .004).Life-space may be a useful identifier of community-dwelling older adults with heart failure at increased risk of ED visits or hospital admissions in the ensuing 6 months. Life-space may therefore be a potentially important component of intervention programs to reduce health care utilization.

Rate ratio

10.1093/gerona/glv076

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Citations (23)

Effects of an Acute Care for Elders Unit on Costs and 30-Day Readmissions

JAMA Internal Medicine (2013)

Kellie L. Flood Paul A. MacLennan Deborah McGrew Darlene Green Cindy Dodd

Providing high-quality care while containing cost is essential for the economic stability of our health care system. The United States is experiencing a rapidly growing elderly population. The Acute Care for Elders (ACE) unit interdisciplinary team model of care has been shown to improve outcomes in hospitalized older adults. The University of Alabama at Birmingham ACE unit incorporates evidence-based care processes. We hypothesized that the ACE model would also reduce costs.To examine variable direct costs from an interdisciplinary ACE compared with a multidisciplinary usual care (UC) unit.Retrospective cohort study.Tertiary care academic medical center.Hospitalists' patients aged 70 years or older spending the entirety of their hospitalization in either the ACE or UC unit in fiscal year 2010.Using administrative data, we analyzed variable direct costs for ACE and UC patients. We also conducted a subset analysis restricted to the 25 most common diagnosis related groups (DRGs) shared by ACE and UC patients. Generalized linear regression was used to estimate cost ratios and 95% confidence intervals adjusted for age, sex, comorbidity score, and case mix index (CMI).A total of 818 hospitalists' patients met inclusion criteria: 428 from the ACE and 390 from the UC unit. For this study group (all DRGs), the mean (SD) variable direct cost per patient was $2109 ($1870) for ACE and $2480 ($2113) for UC (P = .009). Adjusted cost ratios revealed significant cost savings for patients with low (0.82; 95% CI, 0.72-0.94) or moderate (0.74; 95% CI, 0.62-0.89) CMI scores; care was cost neutral for patients with high CMI scores (1.13; 95% CI, 0.93-1.37). Significantly fewer ACE patients than UC patients were readmitted within 30 days of discharge (7.9% vs 12.8%; P = .02). Subset analysis of the 25 most common DRGs revealed a significantly reduced mean (SD) variable direct cost per patient for ACE compared with UC patients ($1693 [$1063] vs $2138 [$1431]; P < .001); cost ratios for total (0.78; 95% CI, 0.70-0.87) and daily (0.89; 95% CI, 0.85-0.94) variable direct costs remained significant after adjustment.The ACE unit team model reduces costs and 30-day readmissions. In an era when improving care processes while reducing costs is a vital objective for the Medicare program and our nation as a whole, the ACE model meets these goals.

Charlson comorbidity index

Acute care

10.1001/jamainternmed.2013.524

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Citations (113)

Table of Contents

Journal of the American Medical Directors Association (2023)

Barbara Resnick Allison Vellega Cari Levy Colleen J. Maxwell Lauren Dayes

Table (database)

10.1016/s1525-8610(23)00239-6

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Characteristics of Frail Older Adult Drivers

Journal of the American Geriatrics Society (2006)

David B. Carr Kellie L. Flood Karen Steger‐May Kenneth B. Schechtman Ellen F. Binder

To determine the prevalence of driving in older adults with mild to moderate physical frailty and to compare characteristics of current frail older adult drivers with those of former drivers in the sample.Retrospective study of frail older adults enrolled in randomized trials of exercise and hormone replacement therapy.Urban, academic medical center.One hundred eighty-three sedentary community-dwelling men and women aged 75 and older with mild to moderate physical frailty, as defined by two of the following three criteria: modified Physical Performance Test (PPT) score between 18 and 32, peak oxygen uptake (VO2) between 10 and 18 mL/kg per minute, and self-report of difficulty or assistance with one activity of daily living (ADL) or two instrumental ADLs. Participants were classified as current or former drivers.Demographic characteristics, medical diagnoses, medication use, modified PPT score, and psychometric tests.The majority (85%) of the participants were drivers. Former drivers were more likely to be older, be female, reside in congregate independent living for the elderly, have a higher incidence of arthritis and congestive heart failure, take sedating medications, have lower total ADL scores, have lower VO2 peak scores, and have more impairment on tests of cognition and physical strength, although only age, type of residence, and grip strength were independent predictors of driving cessation in the regression analysis.Despite the presence of physical frailty, many older adults choose to continue to drive. Further studies are needed to better understand the driving behaviors of frail older adults and explore opportunities for optimizing driving abilities.

10.1111/j.1532-5415.2006.00790.x

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Citations (50)

Interviewing a Grandparent Caregiver With Age-Related Hearing Loss

MedEdPORTAL (2011)

Amanda Soong Hughes Evans Kellie L. Flood

OPEN ACCESSFebruary 14, 2011Interviewing a Grandparent Caregiver With Age-Related Hearing Loss Amanda Soong, MD, H. Hughes Evans, MD, PhD, Kellie Flood, MD Amanda Soong, MD University of Alabama School of Medicine , H. Hughes Evans, MD, PhD UAB , Kellie Flood, MD UAB https://doi.org/10.15766/mep_2374-8265.8186 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstractSince the 1980s, the number of children being raised by their grandparents has increased for a variety of reasons. As the number of grandparent caregivers increases, pediatricians are being exposed to family dynamics and situations that reflect this demographic trend. Since the health and dynamics of the entire family often impact the care we offer as pediatricians, understanding how we best can serve families headed by grandparent caregivers will improve the services we offer our patients.In this simulated case, an older adult brings their grandchild to the emergency room due to a clonidine overdose. Pediatric residents are sent to obtain a history from the grandparent, unaware that the historian has hearing impairment. Specifically, in this case we address effective communication with a caregiver who has presbycusis, or age-related hearing loss. This case also addresses safe medication storage, an important issue to stress with older caregivers, because medications ingested by children belong to their grandparents. After the simulation case is complete, the facilitators and learners gather for a feedback session. They discuss the challenges of interviewing someone with hearing impairment and then hear strategies on how to optimize communication with a hearing impaired historian from geriatric and pediatric faculty. Also discussed is how to address medication safety with families, as well as the proper management of clonidine ingestions. In the process of educating residents and medical students about these specific areas, they become more cognizant of modifying their approach to patients and families with grandparent caregivers. Training pediatricians to work with older adults is a novel and needed approach, and one that will become increasingly important as more pediatric patients are cared for by older adults. This case addresses the following ACGME core competencies: patient care, medical knowledge, interpersonal and communication skills, and professionalism. Educational Objectives By the end of this module, the learner will be able to: Conduct history taking and communication with an older adult caregiver with hearing limitations.Educate on medication safety counseling, especially in the context of common illnesses in older adults.Demonstrate care for a child with clonidine ingestion.Recognize that age-related medical conditions in older adult caregivers impact pediatric care. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Feedback Tool.doc Hearing Limitation Participant Evaluation.doc Hearing Limitations Simulation Case Outline.doc Script for Hearing Limitation Simulation Case.doc Teaching Points.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor's noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2011 Soong et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.KeywordsMedication StorageHearing LossGrandparentsCaregiversHearing ImpairmentPresbycusisIngestionOverdoseClonidine Disclosures None to report. Funding/Support None to report. Loading ...

Interview

Grandchild

Overcrowding

10.15766/mep_2374-8265.8186

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Citations (2)