Start up cost analysis - health dept

Cooperative Re-Engagement Controlled Trial (CoRECT)

Appendix 13b Start up Cost analysis _health department

Start-up cost analysis - health department

OMB: 0920-1133

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Cooperative Re-Engagement Controlled Trial (CoRECT)





Attachment #13b

Start-up Costs for CoRECT

Health Department









Public reporting burden of this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data 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 this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)







Appendix 13b: Start-up Costs for CoRECT

Health Department


Rev: 01/18/2015



 

 

 



Site name: _______________________________________

Completed Date: _________________

 






 

Data collection period (MM/DD/2016 -- MM/DD/2018)


 

 

 

 

 

 

 





The attached cost analysis worksheets are designed to determine how much it costs to implement the intervention that reengages those who are determined out of care respectively - the worksheets will:

- Systematically list the resources needed to implement the CoRECT Study

- Itemize the amount (quantity) of each of the resources used

- Assign dollar values to the resources

The worksheets contain fields for several cost categories listed below. The data will be used to determine the total start-up program costs.

  1. Pre-implementation training

  2. Out-of-care list generation

  3. DIS activities

  4. Administration time

  5. Office supplies

  6. Staff salaries

Sites may update (insert rows) and clarify cost categories and the items listed under each of the cost categories, based on the retention in care project activities performed at that specific site. The data should reflect actual cost or resources allocated under this project, however, some of the data elements may require estimation of costs or resources used based on available information. In such cases, sites may use appropriate data sources or separate calculation to complete the forms.

Evaluation costs that are strictly research-related (e.g., ACASI software, incentives for completing ACASI) should NOT be included in this exercise. However, all resources that are used for project implementation purposes should be included, even if those go beyond specific project funds.













(1) Pre-implementation/ training 

Staff

(ex. study coordinator, DIS, data manager)

Training period

(days)

mmdd-mmdd

Time spent

per day

Per diem

Person 1





Person 2





Person 3





Person 4





Person 5






Training related travel

Staff

(ex. study coordinator, DIS, data manager)

Time spent on travel (hrs)

Mileage

(mile)

Other costs ($)a
















a Include offsite/out-of-state training: parking, taxi fare, and miscellaneous costs, if applicable









(2) Out-of-care lists

Description

Responsible staff

(ex. study coordinator, DIS, data manager)ac

Frequency Count/Week, Month bc

Total Time Spent (hr)b

Generate surveillance line list

Create initial OOC list using surveillance data



_______________

_______/_____

_______/_____

_______/_____


Match with clinic list

Time spent reconciling health department and clinic OOC list



_______________

_______/_____

_______/_____

_______/_____


Communicate with clinic-data transmission (initial)

Transmit reconciled OOC list back to clinic prior to case conference



_______________

_______/_____

_______/_____

_______/_____


Health department preliminary investigation

How much time spent HD staff spent determining if OOC patients are deceased, out of jurisdiction, incarcerated etc



_______________

_______/_____

_______/_____

_______/_____


Case Conference

Time HD staff spent participating in case-conference to complete OOC list



_______________

_______/_____

_______/_____

_______/_____


Communicate with clinic-data transmission (final)

Transmit final OOC list back to clinics prior to case conference



_______________

_______/_____

_______/_____

_______/_____


Data entry of final list

Time spent entering OOC patient data into system to transfer to field epidemiologists/disease intervention specialist



_______________

_______/_____

_______/_____

_______/_____


a List multiple staff if applicable; labor cost could be calculated based on median wage or directly from the activity log data.

b Data in this column reflect the aggregate over the data collection period, e.g., week or month c Fill out a separate line (staff and hours) for any staff involved in this item







(3) DIS Activities

Description

Responsible staff

(ex. study coordinator, DIS, data manager) a

Frequency Count/Week, Month b

Total Time Spent (hr)b

Records review

Time spent reviewing OOC patient records prior to initiating



_______/_____


Outreach to locate and contact OOC patients

Time spent to contact OOC patients including phone calls, databases, in-person visits



_______/_____


Out of care interview/barriers to care survey

Initial interview with OOC patients to assess why have not returned to HIV medical care



_______/_____


Engagement assistance

Activities that assist in re-engagement (ie ARTAS intervention)



_______/_____


Follow-up with clinics

Time spent communicating with clinics to enable clinic or phlebotomy visits



_______/_____


Follow-up engagement assistance

Transition to Care-Activities to complete patient hand-off with-in one week of patient re-linkage visit.



_______/_____


Documentation of engagement assistance into database

Time spent entering activities conducted to engage OOC patients and re-link to clinics for HIV medical care



_______/_____


a List multiple staff if applicable; labor cost could be calculated based on median wage or directly from the activity log data.

b Data in this column reflect the aggregate over the data collection period, e.g., week or month.









(4) Administration Time

Responsible staff

(ex. study coordinator, DIS, data manager) ac

Frequency Count/Week, Month bc

Total Time Spent (hr)b

Project-related meetings



_______________

_______/_____

_______/_____

_______/_____


Data management




_______________

_______/_____

_______/_____

_______/_____


Quality assurance checks




_______________

_______/_____

_______/_____

_______/_____


General administrative duties




_______________

_______/_____

_______/_____

_______/_____


Project supervision




_______________

_______/_____

_______/_____

_______/_____


Other (specify): __________________




_______________

_______/_____

_______/_____

_______/_____


Other (specify): __________________




_______________

_______/_____

_______/_____

_______/_____


a List multiple staff if applicable; labor cost could be calculated based on median wage or directly from the activity log data.

b Data in this column reflect the aggregate over the data collection period, e.g., week or month c Fill out a separate line (staff and hours) for any staff involved in this item











(5) Office supplies and materials





Description


Quantity

Unit

Monthly total




cost ($)

Cost ($)

Office supplies/stationeries


________

$________

$________

Printed material provided to patients


________

$________

$________

Appointment reminder cards


________

$________

$________

Postage


________

$________

$________

Calendar/day planner


________

$________

$________

File folder/organizers


________

$________

$________

Translation of materials


________

$________

$________

Posters, brochures


________

$________

$________

Other (specify)______________


________

$________

$________

Other (specify)______________


________

$________

$________

Other (specify)______________


________

$________

$________



(6) Health Department Staff

Annual salary (exclude fringe)

Fringe benefit (%)

% time spent in this project

Surveillance Coordinator

$__________

__________ %

__________ %

Data manager

$__________

__________ %

__________ %

DIS

$__________

__________ %

__________ %

CoRECT Study Coordinator

$__________

__________ %

__________ %

Others (specify _____________________)

$__________

__________ %

__________ %

Others (specify _______________________)

$__________

__________ %

__________ %

Others (specify ______________________)

$__________

__________ %

__________ %



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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCamp, Nasima Marguerite (CDC/OID/NCHHSTP) (CTR)
File Modified0000-00-00
File Created2021-01-24

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