There is little information available on the predictors of long-term outcomes of older patients with traumatic brain injury (TBI). Without this information, clinical decision-making and discharge planning will continue to be limited, thereby preventing ideal patient-centered, cost-effective, and appropriate care for older patients with TBI. The objective of this application is to merge multiple sources of valuable data to examine predictors of meaningful outcomes, particularly functional and cognitive improvement and the ability to return home following post-acute (PAC) rehabilitative care, among older patients age 65+ years with TBI. The rationale that underlies this proposed research is that an understanding of predictors of improvement in physical and cognitive function, PAC therapies provided to patients, and subsequent healthcare utilization and outcomes could impact care for older patients with TBI. Guided by an experienced interdisciplinary team with statistical and clinical expertise, this proposal has two specific aims: 1) To create a national longitudinal database that follows older patients with TBI across multiple healthcare settings and 2) To identify patient characteristics that predict community discharge and functional improvement during the PAC rehabilitative episode. Under the first aim, the team will use deterministic and probabilistic matching to merge data from the National Trauma Data Bank, the largest aggregation of national trauma registry data, with Medicare claims, the Minimum Data Set (MDS), and the IRF Patient Assessment Instrument (IRF-PAI). This is innovative because it will identify and retrospectively follow a national cohort of older patients with TBI from hospital admission through PAC discharge and include rich data on their injury characteristics, health, and function. Under the second aim, the team will identify the health and contextual factors that are associated with older patients? functional improvement and ability to return to the community following rehabilitation. The contribution of this work will be significant because it will provide patients, family members, providers, and healthcare systems with strong evidence needed to provide high quality TBI care for older patients at a reasonable cost. The expected benefit of this research is evidence that will: 1) enable clinicians to better understand the recovery trajectory and potential outcomes for older patients with TBI; 2) inform organization of care and rehabilitation services; 3) assist family members in setting expectations; 4) promote informed discharge planning; and 5) ultimately, enhance the health, independence, and quality-of-life of older adults with TBI. In addition, this work provides the first step in a continuum of research to be proposed in future R01 grant applications that is expected to elucidate the comparative effectiveness of different types and intensities of PAC therapies, other longer-term health outcomes (e.g., community independence) and healthcare utilization (e.g., hospital readmission, hospice care, home health) for patients with TBI.
The proposed research is relevant to public health because an ability to measure and track the injury profiles, patient characteristics, healthcare utilization, and outcomes of older patients with traumatic brain injury will inform the delivery of care to this ever-growing population. Thus, the benefits of this work align fully with the NIH mission of the application of ?knowledge to enhance health, lengthen life, and reduce the burdens of illness and disability.?