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U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion

Increase the percentage of adults who resume more than half of their usual activities 5 years after traumatic brain injury rehabilitation — DH‑06 Data Methodology and Measurement

On this page:  About the National Data  |  Methodology  |  History

About the National Data

Data

Data Source:  Traumatic Brain Injury Model Systems National Database (TBIMS NDB), Craig Hospital, TBIMS National Data and Statistical Center, Englewood, Colorado

Baseline: 31.0 percent of adults can resume more than half of their preinjury activities (with or without supports) 5 years after receiving acute inpatient rehabilitation for traumatic brain injury in 2017-19

Target: 35.7 percent

Numerator

The number of adults with a GOS-E score of 7 (Lower Good Recovery) or 8 (Upper Good Recovery) at 5 years post-admission, among adults (≥18 years at injury) who received acute inpatient rehabilitation for a primary diagnosis of TBI and were discharged alive.

Denominator

The number of adults with a GOS-E score of 1 (Deceased) — 8 (Upper Good Recovery) at 5 years post-injury, among adults (≥18 years at injury) who received acute inpatient rehabilitation for a primary diagnosis of TBI and were discharged alive.

Target-setting method
Minimal statistical significance
Target-setting method details
Minimal statistical significance, assuming the same standard error for the target as for the baseline.
Target-setting method justification
Trend data were evaluated for this objective, but it was not possible to project a target because the trend was moving away from the desired direction. The standard error was used to calculate a target based on minimal statistical significance assuming the same standard error for the target as for the baseline. This method was used because the Healthy People 2030 Workgroup Subject Matter Experts (SMEs) expected incremental progress over the next decade.

Methodology

Questions used to obtain the national baseline data

(For additional information, please visit the data source page linked above.)

The Glasgow Outcome Scale - Extended (GOS-E) is an ordinal scale that measures global function (Wilson et al., 1998). Patient status is classified into one of eight categories:

  1. Deceased
  2. Vegetative State (only reflex responses)
  3. Lower Severe Disability (needs assistance and cannot be left alone for 8 hours)
  4. Upper Severe Disability (needs assistance but can be left alone for 8 hours)
  5. Lower Moderate Disability (independent at home but not able to return to work even with special arrangements)
  6. Upper Moderate Disability (independent at home and able to return to work with special arrangements)
  7. Lower Good Recovery (independent with the capacity to work, but minor disability)
  8. Upper Good Recovery (independent with the capacity to work and no disability)

Wilson JT, Pettigrew LE, Teasdale GM. Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use. J Neurotrauma. 1998 Aug;15(8):573-85. doi: 10.1089/neu.1998.15.573. PMID: 9726257.

Methodology notes

The rate of Good Recovery will be computed using GOS-E as numerator / denominator (scores 7-8 / scores 1-8). A score of 7 is described as “minor problems that affect daily life; resumes >50% of the pre-injury level of social and leisure activities.”

Sampling weights will be incorporated in analyses to provide national estimates that are representative of the population of adults (≥18 years) who received acute inpatient rehabilitation for a primary diagnosis of TBI and were discharged alive. In order to account for loss to follow-up at 5 years post-injury (participant lost, refused, incarcerated, withdrew, or there was no funding for follow-up at center) weighting and raking methods will be used to adjust sampling weights for non-responder bias prior to analysis.

The measure uses a 3-year average to reliably report data for select population groups that have small sample sizes.

History

Revision History
Recategorized. 

This objective was recategorized from developmental objective DH-D02 to a core objective in 2022. The title was also changed from "Increase the proportion of adults with traumatic brain injury who are able to resume 50 percent or more of preinjury activities 5 years after acute rehabilitation."