Cost analysis - baseline

Cooperative Re-Engagement Controlled Trial (CoRECT)

Appendix 13a Baseline_Standard of Care costs _clinic

Cost analysis- baseline

OMB: 0920-1133

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Cooperative Re-Engagement Controlled Trial (CoRECT)





Attachment #13a

Baseline /Standard of Care Costs CLINIC











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 13a: Baseline /Standard of Care Costs CLINIC


Rev: 01/18/2015



 

 

 



Site name: _______________________________________

Completed Date: _________________

 






 

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


 

 

 

 

 

 

 


Variable

Description

Responsible staff

(ex. nurse, social worker, physician)a

Frequency Count/Week, Month b

Total Time Spent (hr)b

Generate missed visit list (per activity or event)

Time spent generating list for patients that have missed appointments


_______/_____


Records review (per patient)

Review of medical charts prior to contacting patients


______/_____


Outreach to patient (per patient)

Time spent attempting to reach patients with missed appointments (ex: phone calls, mailing letters, sending emails or texts)


______/_____


Engagement assistance (per patient)

Once contact patient, how much time is spent facilitating re-engagement (i.e.: coordinating transportation, case management, expedited appointment )


______/_____


Documentation of engagement assistance (per patient)

Time spent documenting in medical chart attempts made to contact patient and outcome


______/_____


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.











Please check each activity that is applicable and record the time spent in minutes.

Activity

Time Spent (min)


Activity

Time Spent (min)

Generate missed visit list (per activity or event)

___ Time spent generating list for patients that have missed appointments

_____/min


Records review (per patient)

___ Review of medical charts prior to contacting patients

_____/min

Outreach to patient (attempting to reach patients with missed appointments, per patient)

___phone calls

___mailing letters

___sending emails or texts

___others:

_____/min


Engagement assistance (once contact patient, how much time is spent facilitating re-engagement, per patient)

___coordinating transportation

___case management

___expedited appointment

___Others:

_____/min

Time spent documenting in medical chart attempts made to contact patient and outcome (per patient)

_____/min















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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