Chronic Care Management of Geriatric Traumatic Brain Injury

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ABSTRACT Traumatic brain injury (TBI) among older adults has emerged as a new silent epidemic. Older age is associated with long-lasting symptoms and poorer outcomes after injury. A need exists for an acute-to-chronic disease model of traumatic brain injury to guide the chronic care management of older adults with TBI. Limited evidence exists on the patterns and continuity of care following discharge from acute and post-acute care to the community after TBI. This mixed-methods Mentored Research Scientist Development Award (K01) will generate data on the patterns and continuity of care to identify disparities in care and inform initiatives to improve quality of care of older adults with TBI following hospital discharge. The overarching goal of this NIA K01 award is to provide the candidate with a better understanding of the needs and provision of care of older adults with TBI, advanced analytical skills to evaluate care delivery, skills in translating evidence into health initiatives to improve care, and development of an independent research program contributing to improving health outcomes of older adults with TBI. The candidate's mentoring team includes well-established researchers in geriatric medicine, post-acute care, health services, mixed methodology, quality improvement, implementation sciences, and health disparities. The candidate will receive mentorship and training in four essential areas to achieve her career goals, which are to: (1) understand the clinical care processes and health care policies influencing health care delivery of older adults; (2) increase proficiency in advanced analytical approaches to evaluate health care delivery for older adults using administrative claims data; (3) develop, adapt, and evaluate real-world evidence-based interventions to improve health care delivery for older adults; and (4) accelerate career trajectory to becoming an NIH-funded investigator focused on improving care for older adults with TBI. Using Medicare data (2015-2018), the training activities will prepare her to address the following specific aims, which are to: (1) determine the patterns of care in older adults with TBI during the year following acute discharge; (2) explore facilitators and barriers to continuity of care, and elicit stakeholder recommendations to improve care following acute discharge among older adults with TBI, caregivers, and healthcare personnel; and (3) examine the association between continuity of care and health outcomes following acute discharge among older adults with TBI. The findings from this K01 will contribute to describing current practice, and integrate stakeholder perspectives to guide efforts to address disparities in care receipt. Through the research aims and career development training activities, the candidate will be better equipped to submit an R01 to evaluate the effect of implementing an evidence-based, patient-informed transitional care intervention to improve care continuity and health outcomes following discharge among older adults with TBI.