Component A&B Template - Worksheets/Performance Measures

Performance Measurement and Program Monitoring (Autism and Developmental Disabilities Monitoring (ADDM) Network

Attachment 4A_ADDM Performance Measures Data Collection Tool.xlsx

Component A ONLY (Subsequent 6-month and 2-year submission) - WORKSHEETS

OMB: 0920-1124

Document [xlsx]
Download: xlsx | pdf

Overview

Performance measures, SP
6-month worksheet
ESY worksheet


Sheet 1: Performance measures, SP

Form Approved








OMB No. 0920-XXXX








Exp. Date XX/XX/XXXX








Strategic Plan Template




































































Instructions:








The strategic plan is intended to help you plan the activities your site will implement to achieve each of the five ADDM strategies, set performance targets, and select suggested performance measures








on which your site will report. The strategic plan should be developed for the period between Jan 1, 2015 – December 31, 2016 and refer to activities that will be conducted for the 2014 surveillance year,








with the exception of activities related to Strategy 3 (data analyses), which may cover prior surveillance years.








Please scroll down to complete the template for each of the five ADDM strategies.








Your strategic plan should be completed and submitted to CDC no later than June 30, 2015.








The Status of Activities and Notes/Challenges columns should be updated and reported to CDC every 6 months.








Definitions for each of the data elements requested below are provided in the ADDM Network Performance Measurement Reporting Guidelines.


















An agency many not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current valid OMB control number. Send comments regarding this burden estimate or any








other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (XXXX-XXXX)




























Strategy 1 (S1) Component A: 8-year-old ASD+CP or ASD+ID Surveillance


















Planned activities Related output Lead personnel Target start date Target end date Status of activities
Notes/ challenges


















































































































Key performance measures 6 month target 12 month target 18 month target End of surveillance year (ESY) target
Denominator Percent Denominator Percent Denominator Percent Denominator Percent

% of educational data sources for which access to data has been secured or renewed








% of health data sources for which access to data has been secured or renewed








% of education records for which review has been completed - 8yr olds








% of health records for which review has been completed - 8yr olds








Select a suggested measure, if appropriate








Select a suggested measure, if appropriate



























Strategy 2 (S2) Component B: 4-year-old ASD+CP or ASD+ID Surveillance


















Planned activities Related output Lead personnel Target start date Target end date Status of activities
Notes/ challenges


















































































































Key performance measures 6 month target 12 month target 18 month target End of surveillance year (ESY) target
Denominator Percent Denominator Percent Denominator Percent Denominator Percent

% of educational data sources for which access to data has been secured or renewed








% of health data sources for which access to data has been secured or renewed








% of early intervention data sources for which access to data has been secured or renewed








% of education records for which review has been completed - 4yr olds








% of health records for which review has been completed - 4yr olds








% of early intervention records for which review has been completed - 4yr olds








Select a suggested measure, if appropriate








Select a suggested measure, if appropriate



























Strategy 3 (S3) Site-Initiated Analyses


















Planned activities Related output Lead personnel Target start date Target end date Status of activities
Notes/ challenges


















































































































Key performance measures 6 month target 12 month target 18 month target End of surveillance year (ESY) target
Denominator Percent Denominator Percent Denominator Percent Denominator Percent

# of required analyses completed








Select a suggested measure, if appropriate








Select a suggested measure, if appropriate








Select a suggested measure, if appropriate








Select a suggested measure, if appropriate



























Strategy 4 (S4) Community Education & Outreach


















Planned activities Related output Lead personnel Target start date Target end date Status of activities
Notes/ challenges


















































































































Key performance measures 6 month target 12 month target 18 month target End of surveillance year (ESY) target
Denominator Percent Denominator Percent Denominator Percent Denominator Percent

# of education/outreach activities conducted








# of education/outreach activities targeting under-identified groups








# of data sources Community Report/ State Page disseminated to per year








Include your own performance measures for the additional required activities








Include your own performance measures for the additional required activities








Include your own performance measures for the additional required activities








Include your own performance measures for the additional required activities








Include your own performance measures for the additional required activities








Include your own performance measures for the additional required activities



























Strategy 5 (S5) Monitoring & Evaluation


















Planned activities Related output Lead personnel Target start date Target end date Status of activities
Notes/ challenges












































































































































Key performance measures 6 month target 12 month target 18 month target End of surveillance year (ESY) target
Denominator Percent Denominator Percent Denominator Percent Denominator Percent

# of months that site meetings were held to track efforts towards achieving strategic plan and required performance measures








Average abstraction % concordance per reporting period








Sheet 2: 6-month worksheet

ADDM Network 6-month Performance Measures














Instructions:






Please use the table below to enter data for the performance measures listed. You may enter data into cells that are not greyed out.
Data reported should reflect activities completed for the period between January 1 - June 30, 2015 and refer to activities conducted for the 2014 surveillance year.
For measures asking for percent, please enter the numerator and denominator and the percent will be automatically calculated.









6-month Performance Measures














A B C D E F G
ADDM Strategy Performance measure Numerator/ Count Denominator Percent Yes/No Notes/Comments
Strategy 1 & 2 % of new abstractors that completed the new abstractor training

#DIV/0!


Strategy 1 & 2 % of new clinician reviewers that completed the ADDM Network clinician review training modules and achieved a minimum 90% reliability agreement with consensus

#DIV/0!


Strategy 1 & 2 % of clinician reviewers whose ongoing reliability scores fell below the minimum 90% agreement with primary/consensus coding

#DIV/0!


Strategy 1 & 2 Did the Project Coordinator complete all required training?





Strategy 1 & 2 Does your site have a plan to address concordance rates that are near or below 80%?





Strategy 4 # of education/outreach activities conducted





Strategy 4 # of education/outreach activities targeting under-identified groups





Strategy 4 # of different types of target audiences reached





Strategy 4 Approximate number of people reached through education/outreach activities (please select from drop down option provided)





Strategy 4 Insert your additional performance measure here

#DIV/0!


Strategy 4 Insert your additional performance measure here

#DIV/0!


Strategy 4 Insert your additional performance measure here

#DIV/0!


Strategy 4 Insert your additional performance measure here

#DIV/0!


Strategy 4 Insert your additional performance measure here

#DIV/0!


Strategy 4 Insert your additional performance measure here

#DIV/0!


Strategy 5 Average abstraction % concordance per reporting period

#DIV/0!



Sheet 3: ESY worksheet

ADDM Network End-of-Surveillance-Year (ESY) Performance Measures












Instructions:





Please use the table below to enter data for the performance measures listed. Please note that the grey cells are locked. You may enter data into cells that are not greyed out.
Data reported should reflect activities completed for the period between January 1, 2015 - December 31, 2016 and refer to activities conducted for the 2014 surveillance year.
For measures asking for percent, please enter the numerator and denominator and the percent will be automatically calculated. For measures asking for Yes/No response, please click the down arrow to select a response from the drop down menu.
Measures marked as 'Optional' denote measures that are not included in the FOA. Measures with an asterix (*) are included in the strategic plan template.







End-of-Surveillance-Year Performance Measures












A B C D E F G
ADDM Strategy Performance measure Numerator/ Count Denominator Percent/Average Yes/No Notes/Comments
Strategy 1 & 2 Were final case records linked to community indicators based on geocoding?




Strategy 1 & 2 Were final case records linked to birth certificates?




Strategy 1 & 2 % of monthly clinician review reliability calls your site participated in

#DIV/0!

Strategy 4 # of data sources Community Report/State Page disseminated to*




Strategy 5 Did any clinician reviewers fall below an 80% reliability score?*




Strategy 5 If yes, have they reestablished their reliability by reviewing additional records?*




Strategy 5 # of months that site meetings were held to track efforts towards achieving strategic plan and required performance measures*




Strategy 5 Are you aware of any new/modified policies related to ASD within your surveillance area? [OPTIONAL]




Strategy 5 Are you aware of any new research that has been planned/initiated to look further into the findings from the ADDM Network? [OPTIONAL]




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