Leveraging existing data resources to characterize health and clinical care among older adults with traumatic brain injury

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Project Summary/Abstract The population of older adults living with traumatic brain injury (TBI) has increased precipitously in the last decade. Current clinical care guidelines for TBI do not offer any specific recommendations for the clinical care of older adults, despite substantial evidence that primary injury mechanisms and secondary injury sequela are markedly different in older as compared to their younger counterparts. In addition to increased rates of incident TBI in this age cohort, many individuals who have sustained TBI earlier in life are surviving to older age and living with chronic disability from their injuries. There is a need for research to better understand the short-term and longer-term clinical care needs for older persons living with TBI. Existing hospital-based registries and TBI cohort studies have limited information on health care use after discharge from acute and post-acute health care settings; therefore, our current knowledge of health care needs for older adults living with TBI are confined by these limitations. The use of Medicare data linked to existing research cohorts is widely practiced in other biomedical fields, but these linkage methods are under-utilized in TBI research. The overall objectives of this K99/R00 proposal are to characterize the health, function, and clinical care pathways among older adults with TBI by leveraging Medicare claims combined with multiple data resources, including: the National Trauma Databank, Health and Retirement Study, and TBI Model Systems National Database. The K99 specific aims are: 1) to identify prognostic characteristics associated with the proportion of time spent in different health care settings in the first year after post-acute TBI care admission, and 2) to compare function, health, and health care utilization and cost among current older adults with remote TBI exposure, incident TBI in later life, and no history of TBI. 3) During the R00 portion of the grant, we will use probabilistic matching to link the TBI Model Systems National Database with Medicare claims to develop a rich new infrastructure that will support future investigation into associations between rehabilitation care utilization patterns and longitudinal patient-reported TBI outcomes among current older adults with TBI. This innovate research exploits unique strengths from multiple complementary existing data resources in hospital and community-based settings to address novel TBI rehabilitation-relevant questions. The proposed research and training plan will address the following knowledge gaps during the K99 period: 1) training in analysis of administrative claims and cost data, 2) analysis of population-based databases for rehabilitation research, 3) training in data linkage and harmonization, 4) understanding the health care experiences of older adults with TBI and their caregivers, and 5) refining skills in grant writing. The knowledge gained from the proposed research and training is significant because it will advance our knowledge of the health and health care needs of current older adults living with TBI to inform age-appropriate models of care.