Start up cost analysis - clinic

Cooperative Re-Engagement Controlled Trial (CoRECT)

Appendix 13c Start up Cost analysis _clinics

Start up cost analysis - clinic

OMB: 0920-1133

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Form Approved

OMB No. 0920-New

Expiration Date: XX/XX/XXXX









Cooperative Re-Engagement Controlled Trial (CoRECT)





Attachment #13c

Start-up Cost Analysis

CLINICS









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 13c: Start-up Costs for CoRECT

CLINIC COSTS


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. Administration time

  4. Re-engagement/handoff to clinic

  5. Staff salaries

Clinical 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

Description

Training period (days)

mmdd/mmdd

Time spent

Per diem ($)

CoRECT study clinic manager/nurses

Train clinic staff to generate initial lists of OOC patients



_____ hr/day


Data manager

Time spent training data management transmit data to health department



_____ hr/day


Other:



_____ hr/day


Other:



_____ hr/day




(2) Out-of-care lists

Description

Responsible staff

(ex. clinic nurse, 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 HD list

Time spent reconciling health department and clinic OOC list



__________________

_______/____

_______/___________/____


Communicate with HD-data transmission (initial)

Transmit reconciled OOC list back to clinic prior to case conference



__________________

_______/____

_______/____

_______/____


Case Conference

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



__________________

_______/____

_______/____

_______/____


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) Administration Time

Responsible staff

(ex. clinic nurse, physicians, 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










(4) Re-engagement/ handoff to clinic

Description

Responsible staff

(ex. clinic nurse,data manager)ac

Frequency Count/Week, Month bc

Total Time Spent (hr)b

Staff time spent contacting OOC patients

Appointment reminders, missed visit contacts, support service contacts



______________

_______/_____

_______/_____

_______/____


Follow-up with health department

Time spent communicating with DIS/field epi to schedule re-engaged patients for medical or phlebotomy visits



______________

_______/_____

_______/_____

_______/____


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) Clinic program staff salary




Clinics Staff

Annual salary (exclude fringe)

Fringe benefit (%)

% time spent in this project

Clinic Physician

$__________

__________ %

__________ %

Clinic data manager

$__________

__________ %

__________ %

Clinical nurse 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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