Comorbidity in traumatic brain injury and risk of all-cause mortality, functional and financial burden: a decade-long population based cohort study

资助机会：对现有创伤性脑损伤数据库进行二次分析以探索 与医疗康复相关的结果(R21)；RFA-HD-16-001 《少年派：科兰托尼奥A》 项目摘要：创伤性脑损伤(TBI)后和其他地区普遍存在共病 受伤严重程度的范围。它可以在受伤时出现，在受伤后早期出现，或者 在住院或住院康复期间。对以下个人的长期跟踪研究 忍受了一份TBI的报告，即患者有许多共存的疾病。尽管如此，我们的 理解何时(即受伤前或受伤后)、如何(即情况如何) 影响受伤个人及其随后对保健服务的需求)以及 (即，哪些并存条件造成的负担最大)，关于过度使用 资源、功能结果和全因死亡率仍未得到回答。更多的人口- 为了弥补这些研究空白，有必要进行基础研究。建议的回溯队列 这项研究将利用所有具有脑损伤诊断代码的患者的关联数据，这些代码来自紧急情况 科室(国家门诊护理报告系统)、急性护理(出院摘要) (数据库)、住院康复(国家康复系统)、社区服务和 长期护理(家庭护理数据库)、持续护理(持续护理报告系统)和 处方数据(安大略省健康保险计划索赔数据库)在10年内。在… 10年内至少35,000例急性护理病例构成了纵向分析的基础。 这些数据经过了临床研究所的质量评估和联系 评估科学，一个非营利性的独立组织，开展研究以改善 加拿大安大略省医疗保健服务的有效性。我们假设，敏锐地推导出 变量(即年龄、颅内损伤、损伤机制、损伤严重程度、住院时间)- 目前，大多数研究工作的重点是脑外伤和合并症--不是单独的 足以准确预测资源消耗、全因死亡率和功能性 脑外伤患者的预后，按年龄和性别分层。我们进一步假设一个 扩展的一组因素和因素簇，包括患者人口统计、某些临床(即， 同时)障碍和社会指数，将在预测资源方面提供更大的准确性 消耗量、全因死亡率和脑外伤的功能结果，这些集群将是 随着时间的推移会发生变化。这项关于脑外伤患者共病的研究可能会导致 揭示具有挑战性的多方面问题(例如，脆弱性和患者复杂性)，这些问题 目前没有很好的定义，但通常被认为与 多种共病障碍。 2015年10月

FUNDING OPPORTUNITY: Secondary analysis of existing databases in traumatic brain injury to explore outcomes relevant to medical rehabilitation (R21); RFA-HD-16-001 PI: COLANTONIO A PROJECT SUMMARY: Comorbidity is prevalent after traumatic brain injury (TBI) and across the spectrum of injury severity. It can be present at the time of injury, arise early after injury, or during hospitalization or inpatient rehabilitation. Long-term follow-up studies of individuals who had endured a TBI report that patients have numerous co-existing disorders. Nevertheless, our comprehension of the when (i.e., pre- or post-injury presentation), how (i.e., how the conditions affect the injured individual and their subsequent demand for health care services) and which (i.e., which comorbid conditions cause the greatest burden), with respect to excessive use of resources, functional outcomes, and all-cause mortality, remain unanswered. Larger population- based studies are necessary to address these research gaps. The proposed retrospective cohort study will utilize linked data of all patients with TBI diagnostic codes, derived from emergency departments (National Ambulatory Care Reporting System), acute care (Discharge Abstract Database), inpatient rehabilitation (National Rehabilitation System), community services and long-term care (Home Care Database), continuing care (Continuing Care Reporting System), and prescription data (Ontario Health Insurance Plan Claims Database) over a 10 year period. At least 35,000 acute care cases over a 10 year period form the basis of the longitudinal analysis. These data have undergone quality assessments and linkage by the Institute for Clinical Evaluation Sciences, a non-profit independent organization that carries out research to improve the effectiveness of health care services in Ontario, Canada. We hypothesize that acutely derived variables (i.e., age, intracranial injury, injury mechanism, injury severity, length of stay) – currently the focus of most research efforts in TBI and comorbidity – are not by themselves sufficient to accurately predict resource consumption, all-cause mortality, and functional outcomes in individuals with TBI, stratified by age and sex. We further hypothesize that an expanded set of factors and factor clusters including patient demographic, certain clinical (i.e., comorbid) disorders and social indices, will provide greater accuracy in predicting resource consumption, all-cause mortality and functional outcomes of TBI, and these clusters will be subject to change over time. This study of comorbidity in patients with TBI may lead to uncovering challenging multifaceted problems (i.e., frailty and patient complexity) that are currently not well defined but generally considered to be closely related to the presence of multiple comorbid disorders. October 2015