Chronic Care Management of Geriatric Traumatic Brain Injury

摘要 老年人中的创伤性脑损伤(TBI)已成为一种新的无声流行病。年龄越大越好 与持久的症状和受伤后较差的结局有关。存在从急性到慢性的需求 建立创伤性脑损伤疾病模型，指导老年颅脑损伤患者的慢性护理管理。有限 有证据表明从急性和急性后护理出院后护理的模式和连续性 TBI后的社区。这项混合方法指导的研究科学家发展奖(K01)将 生成有关护理模式和连续性的数据，以确定护理方面的差异，并为以下举措提供信息 提高出院后脑损伤老年患者的护理质量。这个NIA的首要目标是 K01奖是为了让候选人更好地了解老年人的需求和提供护理 患有脑外伤的成年人，评估护理服务的高级分析技能，将证据转化为健康的技能 改善护理的举措，并制定有助于改善的独立研究计划 老年脑外伤患者的健康结局。候选人的指导团队包括久负盛名 老年医学、急性后护理、卫生服务、混合方法、质量改进、 实施科学和健康差距。候选人将在四年内接受指导和培训 实现职业目标的基本领域，即：(1)了解临床护理流程和健康 影响老年人保健提供的护理政策；(2)提高高级分析的熟练程度 使用行政索赔数据评估老年人保健服务提供情况的方法；(3)制定、 适应和评估现实世界的循证干预措施，以改善老年人的卫生保健服务； 以及(4)加快职业轨迹，成为NIH资助的研究人员，专注于改善对 患有脑外伤的老年人。使用联邦医疗保险数据(2015-2018)，培训活动将使她做好应对 以下具体目标是：(1)确定一年中患有脑外伤的老年人的护理模式 在急性出院后；(2)探索持续护理的促进者和障碍，并吸引利益相关者 建议改善患有脑外伤的老年人急性出院后的护理，照顾者和 医护人员；以及(3)检查护理连续性和健康结果之间的关联 在患有脑外伤的老年人急性出院后。来自K01的发现将有助于描述 目前的做法，并整合利益攸关方的观点，以指导解决护理接受方面的差异的努力。 通过研究目标和职业发展培训活动，应聘者将更好地掌握 提交R01以评估实施循证、患者知情的过渡性护理的效果 改善老年脑外伤患者出院后护理连续性和健康结局的干预措施。

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.