GenIC XDRCI-COST

1

Attachment Da. Information Transmitting Phone Interview Guide – program manager

XDR TB Contact Investigation: A Cost Assessment

Italicized text not to be said

Form Approved

OMB No. 0920-0879

Expiration Date 03/31/2018

Introduction

• Thank you for collecting this information – I understand that you have experience in (X, Y, Z)

• I am a Prevention Effectiveness Fellow supervised by Suzanne Marks at the CDC

  • Mention a couple of things that we have in common

• As your team mentioned, we are looking for information that will allow us to calculate the economic cost of the contact investigation that resulted from the arrival of the patient with XDR TB to the USA last April

• This collection has been authorized by CDC’s Division of Tuberculosis Elimination and the Office of Management and Budget

• It is an opportunity for the costs of this contact investigation to your TB controller’s office to be heard, and will allow us the opportunity to provide information that will help achieve our goal of tuberculosis elimination in the United States.

• Please be reassured that there are no right or wrong answers. We want you to be as accurate as you can. If you do not yet have a piece of information, but think that you can get it, we can follow up after I have received results from all affected offices. If you do not think that you can obtain the information, please provide your best estimate.

Purpose and scope of interview

• If the respondent has not sent through a filled-in spreadsheet.

  • I would like to take about an hour to ask you about what you found, and enter this information into my spreadsheet

• If I have already received a spreadsheet from the respondent

  • I would like to take about an hour to ask you about what you sent through to ensure that it is the information that we are looking for, and understand what it means more fully

• As you noticed on the spreadsheet, we want to divide the information into two sections:

  • The preparation and initial assessment period from the arrival of the index case to the point that each contact completed their initial diagnosis.

  • The follow up period between the initial diagnoses and point of data collection

  • I will model the costs from the point of data collection to the two year mark

Initial questions and comments

• Do you have any questions before we get started?

• If you have any questions during the interview, please ask them at any time

If the respondent has any reluctance to participate

• Do you have reservations about participating?

• We can reschedule for another time today, or another day in the near future if you prefer

• May I take notes while you are responding?

• This interview will not be recorded, and I will maintain confidentiality of the information

Preparations and initial assessments

• In this section, we want to assess the costs of preparation activities and assessments of each contact up to the point that each received their diagnosis.

1. Location and collaborator information: I will have this knowledge in advance

2. Contact investigation outcomes: Please tell us about the intensity of your activities to inform our descriptive statistics of the investigation. Some of this information will be used to confirm data that I’ve gotten from the Field Services Branch.

• How many hours were spent identifying contacts? Please account for all personnel involved

• How many contacts were identified?

• How did you classify contacts? (ask up front to check what system they used)

  • How many contacts were classified as high, medium, or low priority?

  • Does your state have any deviations from CDC definitions [1]?

or

• How many were classified as close or casual contacts?

• How many contacts were evaluated for TB?

• Was is your confidence in your result?

• What were the sources of this information?

Probes and closing

• Are you sure? (if number of contacts is more than I have recorded on my sheet)

• Please explain that (regarding confidence in results)

• Thank you for providing results for that section

3. Tests administered and results for TB infection and disease: Next we want to ask about the number of tests and examinations that were done to diagnose TB infection and test for disease.

   • How many tests for TB infection and disease were administered during the initial assessment phase of the investigation? (data probably collected from field locations)

   • What were their aggregate outcomes including positive, negative, and indeterminate?

     1. Go through each test

        1. TST

        2. Quantiferon Gold In-Tube

        3. T-Spot

        4. Physical examination

        5. Chest X-Ray

        6. Sputum Induction

        7. Sputum Smear and Culture

        8. Nucleic Acid Amplification test

• What were the sources of this information?

Probe and closing

• How were results equivocal? (If relevant)

• Can you tell me more about that? (if any inconsistencies with total number of contacts)

• Thank you for telling me the results to testing

4. Risk factors for developing TB disease after infection: Risk factors will give us an idea about the probability that contacts may develop disease. What risk factors for developing TB disease after infection did contacts have? (probably measured on the contact investigation form)

   • How did you classify contacts geographically? (i.e. does their system fit well into the categories I have chosen?)

     1. How many contacts were born any of the following regions, or a region not listed?

     2. How many contacts have lived or travelled for more than one month in any of the following regions, or a region not listed? (It doesn’t matter how long ago; remember that foreign born traces contacts back to the point of birth for exposure)

   • How many contacts in your area had any of the following medical risk factors?

     1. Remember that answers are confidential and results will only be presented in aggregate form

     2. Did you find any other risk factors that we have not listed?

   • How many contacts in your area had any of the following non-medical risk factors?

     1. Did you find any other risk factors that we have not listed?

   • What were the sources of this information?

Probe and closing

• Was there anything else?

• Thank you for telling me about the risk factors affecting the contacts in your state

1. Number of personnel: What personnel were involved in the preparation and initial assessment phase of this investigation including investigative, support, and administrative personnel?

• How many personnel from each category were involved?

• Who paid their salaries?

• Were there any other types of personnel involved? (Until they say ‘no’)

• Did any personnel fill two roles?

  • How did they distribute their time across roles? (if relevant)

• What were the sources of this information?

Probes and closing

• Are you sure? (One time after they say ‘no’ about personnel involved)

• You didn’t mention anything about ‘X’ category of personnel. Were any from that group involved? (If there is reason to think that any were omitted)

• Thank you for telling us about these personnel costs

6. Travel components: Did your office incur any travel costs through home visits or other activities during preparations and initial assessments?

   • Do you maintain the information from the travel log or does your accountant? (if the accountant, skip this section)

   • What kinds of travel components were relevant to your investigation?

   • Go through each

     1. Mileage

     2. Per diem

     3. Other component

• How many units were consumed?

• Who paid for it?

• Was there anything else? (To make sure they haven’t left off any travel expense categories)

• Did any of these components include expenses outside what would be required for normal work duties?

• What were the sources of this information?

Probe and closing

• Please explain that (if any uncertainty)

• Thank you for this information on travel costs

7. Training sessions and their components: Were any formal training activities administered during preparations and initial assessments?

   • What types of training were provided?

   • What types of personnel received them?

   • How many of each personnel type received the training in total?

   • How many of each were involved in the contact investigation or its support?

   • What did this training consist of?

   • Did the training occur in multiple sessions?

   • How long is training valid for?

   • What proportion of the training was applied to contact investigation activities, support, or administration?

   • Who provided the training? (probe to see if external or in-house if not immediately clear)

   • Who paid for the training?

   • Was any other formal or informal training provided? (repeat the questions above until the respondent says ‘no’)

   • What were the sources of this information?

Probes and closing

• Please explain that (if any uncertainty)

• Thank you for telling us about these training costs

8. Number of incentives and enablers: What incentives and enablers have you provided to contacts to help them keep and attend their appointments for their initial assessments?

   • What kinds were used?

   • Who paid for them? (go through each one at a time)

Probes and closing

• Were there any other types?

• Please explain that (if any uncertainty)

• Thank you for telling us about these costs of incentives and enablers

9. Number of miscellaneous components: Have we neglected to specify anything from the preparation and initial assessment period that represents a cost incurred?

   • If so:

     1. What types were consumed?

     2. What percent was dedicated to the contact investigation?

     3. Who paid for it?

     4. What were the sources of this information?

     5. Were there any other costs

• Thank you for sharing this information about the costs of this contact investigation during the preparation and initial assessment phase

Please move to the follow up sheet

Follow up sheet

Next, we want to collect costs for the follow up period. This sheet should include information on the period for each contact after they have been diagnosed and classified up to the present time to allow me to make projections for the duration of the two year follow up period. To emphasize, all we want is the cost from the end of the initial assessment period until now.

• Please simply indicate ‘same’ if the valuations are the same as in the preparation and initial assessment period

10. Tests and results for TB infection and disease: How many tests and examinations for TB infection and disease have been administered to this point of follow-up? (data probably collected from field locations)

    • What were their aggregate outcomes including positive, negative, and indeterminate?

    • Go through each test

      1. TST placements

      2. TST readings

      3. QFT

      4. T-spot

      5. Physical examination

      6. Chest X-Ray

      7. Sputum Induction

      8. Sputum Smear and Culture

      9. Nucleic Acid Amplification test

    • What were the sources of this information?

Probes and closing

• How were results equivocal? (If relevant)

• Can you tell me more about that? (if any inconsistencies with total number of contacts)

• Thank you for telling me the results of follow up testing

1. Tests administered and results for TB infection and disease: How much have TB diagnoses cost during the follow-up period to this point?

   • Were any of the costs for these tests different than in the initial assessments phase?

   • Go through each test

     1. TST placements

     2. TST readings

     3. QFT

     4. T-spot

     5. Physical examination

     6. Chest X-Ray

     7. Sputum Induction

     8. Sputum Smear and Culture

     9. Nucleic Acid Amplification test

   • Who paid for them?

• What were the sources of this information?

Probe and closing

• Can you tell me more about that? (If there are any inconsistencies with the number of tests)

• Thank you for telling us about the costs of testing for TB infection and disease

12. Number and types of LTBI treatments: What were the costs of treating contacts for LTBI in the follow-up phase to this point?

    • What regimens were used?

    • How many regimens were initiated?

    • How many doses have been taken to this point?

    • Who paid for it?

Probes and closing

• Are you sure? (if there are any inconsistencies or unlikely regimens)

• Thank you for telling me about LTBI treatment costs involved

13. Number of personnel: What personnel costs were incurred in the follow-up phase to this point including investigative, support, and administrative personnel?

    • Were there any differences in salaries from the initial assessments phase?

    • How many personnel from each category were involved?

    • Who paid their salaries?

• Were there any other types of personnel involved? (until they say ‘no’)

• What were the sources of this information?

Probes and closing

• Are you sure? (One time after they say ‘no’ about personnel involved)

• You didn’t mention anything about ‘X’ category of personnel. Were any from that group involved? (If there is reason to think that any were omitted)

• Thank you for telling us about the personnel costs involved

14. Travel components: Did your office incur any travel costs through home visits or other activities during the follow-up phase to this point?

    • If the accountant maintains this information, skip this section

    • Go through each

      1. Mileage

      2. Per diem

      3. Other component

• How many units were consumed?

• Who paid for it?

• Was there anything else? (To make sure they haven’t left off any travel expense categories)

• Did any of these components include expenses outside what would be required for normal work duties?

• What were the sources of this information?

Probe and closing

• Please explain that (if any uncertainty)

• Thank you for this information on travel costs

15. Training sessions and their components: Have there been any formal training activities administered during the follow-up phase to this point?

    • What types of training were provided?

    • What types of personnel received them?

    • How many of each personnel type received the training?

    • How many of each were involved in the contact investigation or its support?

    • What did this training consist of?

    • Did the training occur in multiple sessions?

    • How long is training valid for?

    • What proportion of the training was applied to contact investigation activities, support, or administration?

    • Who provided the training? (probe to see if external or in-house if not immediately clear)

    • Who paid for the training?

    • Was any other training provided? (repeat the questions above until the respondent says ‘no’)

    • What were the sources of this information?

Probe and closing

• Please explain that (if any uncertainty)

• Thank you for the information on training costs

16. Number of incentives and enablers: What incentives and enablers have you provided to contacts to encourage them to keep and help them attend their appointments during the follow-up period?

    • What kinds were used?

    • Who paid for them? (go through each one at a time)

Probes and closing

• Were there any other types?

• Please explain that (if any uncertainty)

• Thank you for telling us about these costs of incentives and enablers

17. Number of miscellaneous components: Have we neglected to specify anything from the follow-up phase to the point that represents a cost to contact investigation?

    • If so:

      1. What types were consumed?

      2. How many units were consumed?

      3. What percent was dedicated to the contact investigation?

      4. Who paid for it?

      5. What were the sources of this information?

• Thank you for providing this information on the follow up period

Closing

• Do you have any questions?

• Are there any results that you would like to comment on in terms of doubts about their accuracy?

• I would like to review a few things that appear to be discrepancies in results and ask you to follow them up

  • I will have compiled a list during the interview of things not addressed immediately

• We will be back in touch to send you the completed spreadsheet within one month once we receive results from everyone involved to ask you to validate your section

• My phone number and email address are in the instruction sheet if you need to contact me

• Thank you for your collaboration in collecting this information!

References

1. CDC, Guidelines for the investigation of contacts of persons with infectious tuberculosis. Recommendations from the National Tuberculosis Controllers Association and CDC. MMWR, 2005.

2. Harrell, M.C. and M.A. Bradley, Data collection methods. Semi-structured interviews and focus groups. 2009, DTIC Document.



CDC estimates the average public reporting burden for this collection of information as up to 1 hour per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879).