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

项目摘要/摘要 年，患有创伤性脑损伤(TBI)的老年人人数急剧增加 过去十年。目前的脑损伤临床护理指南没有为临床提供任何具体的建议。 照顾老年人，尽管有大量证据表明，初级伤害机制和继发性伤害后遗症 与年轻的同龄人相比，年长的人有明显的不同。除了提高 事件脑损伤在这个年龄段，许多早年遭受脑损伤的人都能活到更老的年龄 他们的年龄和生活因其受伤而长期残疾。有必要进行研究，以更好地了解 老年脑外伤患者的短期和长期临床护理需求。现有以医院为基础 登记和TBI队列研究中关于急性和非传染性疾病出院后医疗保健使用的信息有限 急性后卫生保健环境；因此，我们目前对老年人保健需求的了解 使用TBI的人受到这些限制的限制。与现有研究队列相关联的联邦医疗保险数据的使用是 广泛应用于其他生物医学领域，但这些连锁方法在脑损伤研究中未得到充分利用。 这份K99/R00提案的总体目标是描述健康、功能和临床的特征 结合多项数据利用医疗保险索赔在老年脑外伤患者中的护理路径 资源，包括：国家创伤数据库、健康和退休研究以及TBI模型系统 国家数据库。K99的具体目标是：1)确定与 急性颅脑损伤后护理入院后第一年在不同卫生保健环境中度过的时间比例， 2)比较当前老年人的功能、健康和医疗保健利用情况以及费用 有脑外伤暴露史，晚年有脑外伤事件，无脑外伤病史。3)在赠款的R00部分，我们将 使用概率匹配将TBI模型系统国家数据库与联邦医疗保险索赔联系起来，以开发 丰富的新基础设施，将支持未来对康复护理之间关系的调查 目前患有脑外伤的老年人中的利用模式和纵向患者报告的脑损伤结果。这 创新研究从医院现有的多个互补数据资源中挖掘独特优势 以及以社区为基础的环境，以解决与脑损伤康复相关的新问题。 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)行政索赔和费用数据分析方面的培训；2)人口数据库分析 用于康复研究，3)数据联系和协调方面的培训，4)了解保健 患有脑外伤的老年人和他们的照顾者的经验，以及5)在赠款撰写方面的精炼技能。《知识》 从拟议的研究和培训中获得的好处是重要的，因为它将促进我们对 目前患有脑外伤的老年人的健康和保健需求，以提供适合年龄的护理模式。

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.