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

项目概要/摘要 患有创伤性脑损伤（TBI）的老年人人数在2010年急剧增加。 过去十年。目前TBI的临床护理指南没有提供任何具体的临床建议。 老年人的护理，尽管有大量证据表明，原发性损伤机制和继发性损伤后遗症 老年人与年轻人相比有明显的不同。除了增加的 在这个年龄组中，许多在生命早期遭受TBI的个体存活到老年， 年龄和生活与慢性残疾从他们的伤害。有必要进行研究，以更好地了解 老年创伤性脑损伤患者的短期和长期临床护理需求。现有医院 登记研究和TBI队列研究中关于急性脑损伤患者出院后医疗保健使用的信息有限， 急性期后的医疗保健环境;因此，我们目前对老年人生活的医疗保健需求的了解 TBI患者受到这些限制的限制。使用与现有研究队列相关的医疗保险数据是 广泛应用于其他生物医学领域，但这些联系方法在TBI研究中未得到充分利用。 本K99/R 00提案的总体目标是表征健康、功能和临床 通过利用医疗保险索赔与多种数据相结合， 资源，包括：国家创伤数据库，健康和退休研究，TBI模型系统 国家数据库。K99的具体目标是：1）识别与肿瘤相关的预后特征， 急性TBI后入院治疗后第一年在不同医疗机构花费的时间比例， 和2）比较功能，健康，和医疗保健利用和成本之间的当前老年人与远程 TBI暴露，在以后的生活中发生TBI，并且没有TBI病史。3)在R 00部分的赠款，我们将 使用概率匹配将TBI模型系统国家数据库与医疗保险索赔联系起来， 丰富的新的基础设施，将支持未来的调查之间的关联康复护理 当前患有TBI的老年人的利用模式和纵向患者报告的TBI结局。这 创新研究利用医院多种互补现有数据资源的独特优势 和社区为基础的设置，以解决新的TBI康复相关的问题。 拟议的研究和培训计划将解决K99期间的以下知识差距 期间：1）行政索偿和费用数据分析培训，2）人口数据库分析 康复研究，3）数据链接和协调培训，4）了解医疗保健 老年人与TBI和他们的照顾者的经验，和5）完善的赠款写作技能。知识 从拟议的研究和培训中获得的信息是重要的，因为它将增进我们对 健康和医疗保健需求的当前老年人与TBI的生活，以告知年龄适当的护理模式。

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.