Attachment 4 - OD2A State Reporting Template.xlsx
XLSX spreadsheet 91 KB Posted
- Attached to
- Overdose Data to Action in States (OD2A-S) Program Performance Measurement and Evaluation
- Solicitation number
- 120648 O3
- Issued by
- Lancaster County, Nebraska
About this file
This is a performance measurement reporting tool template from the CDC for the Overdose Data to Action in States (OD2A-S) program. The template consists of 8 tabs designed to capture data on various performance measures including health equity activities, harm reduction encounters, naloxone distribution, navigators linking people who use drugs to care, referrals to care and harm reduction services, clinician training on CDC opioid prescribing guidelines, and implementation of substance use disorder protocols in clinical settings. The tool requires jurisdictions to report detailed counts and disaggregated data across multiple categories including settings (clinical, harm reduction, public safety), demographics, and organizational types.
The reporting template includes specific data entry instructions for each measure, requiring jurisdictions to enter whole numbers for all counts without suppressing small numbers. Key metrics tracked include total naloxone doses distributed, number of harm reduction service encounters, number of navigators providing warm handoffs, referrals by race/ethnicity, and number of clinicians trained. The tool uses formula fields to automatically calculate totals once disaggregated data is entered. Optional reporting elements include navigator hours by setting type, clinician training by specialty, and detailed geographic distribution data by zip code.
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START HERE
| OD2A-S Performance Measures Reporting Tool |
| Instructions |
| Note: This tool is best viewed in the desktop version of Microsoft Excel. |
This reporting tool was designed for OD2A-S programs to support data collection, as well as reporting on required performance measures for evaluation to CDC. The tool is organized into 8 distinct tabs that are named by the performance measure labels provided in the Indicator Reference Sheets. Specifically, these tabs will capture data on the primary unit of measure and disaggregates. Within this tool some cells will appear gray to indicate that no additional data entry is needed.
After completing each required tab in this tool, please save your file using the following naming convention before uploading the Excel file to the Performance Measures section of Partner's Portal: OD2AS Reporting Template_Jurisdiction_Submission Date
Partner's Portal Any contextual questions/metadata that align to each performance measure will be entered into Partner's Portal. Due to the qualitative nature of the HE_Impact measure, this measure will be reported in Partner's Portal.
Technical Guidance Please see the Indicator Reference Sheets and glossary of the technical guidance for definitions that have been developed to help operationalize each performance measure. For additional details about the reporting process, refer to the technical guidance.
Feel free to reach out to your Evaluation Officer if you have additional questions about using this tool.
Select your jurisdiction
Select reporting period
| Data Entry Instructions | ||
| Variable/Disaggregate | Reporting Specifications | |
| Jurisdiction | This field will be prepopulated for all rows of data based on the selection made in the drop-down from 'Select your jurisdiction' from the Start Here tab. The cells will appear gray to indicate that no additional data entry is needed. | |
| Reporting_Period | This field will be prepopulated for all rows of data based on the selection made in the drop-down for 'Select reporting period' from the Start Here tab (See technical guidance for reporting timeline table.) The cells will appear gray to indicate that no additional data entry is needed. | |
| HE_Activities | ||
| Total_HE_Activities | This is a formula field that will generate a total count of health equity focused overdose prevention activities that occurred in a clinical, harm reduction, public safety, or other settings during the designated reporting period once the disaggregates below are entered into the appropriate fields. | |
| HE_Clinical_Settings | Enter a whole number for the health equity focused overdose prevention activities that occurred in a health/clinical setting. | |
| HE_HR_Settings | Enter a whole number for the health equity focused overdose prevention activities that occurred in a harm reduction setting. | |
| HE_Public_Safety_Settings | Enter a whole number for the health equity focused overdose prevention activities that occurred in a public safety setting. | |
| HE_Other_Settings | This disaggregate is optional. If chosen, enter a whole number that reflects the health equity focused overdose prevention activities that occurred in any setting outside of clinical, harm reduction, and public safety. | |
| HR_Encounters | ||
| Total_HR_Encounters | Enter a total count of harm reduction service encounters (e.g., in-person, mail, telephone, online) that occurred at an OD2A-S funded or supported organization during the designated reporting period. | |
| Encounters_with_Drug_Checking | Enter a whole number for service encounters where in-person drug checking occurred. | |
| ZipCode_By_HR_Service_Site | Enter the five-digit zip code for each site where harm reduction services (e.g., in-person, mail, telephone, online) were provided. For any service site where services are provided in person, use the brick and mortar location zip code. For services provided via phone or mail, use the address of the brick and mortar location. For mobile-based outreach services, use the zip code of outreach. For any service sites where zip codes are unknown, provide the total number of encounters that occurred across locations with unknown zip codes in the designated cell for “unknown” within the adjacent cell. | |
| Encounters_with_Drug_Checking_by_ZipCode | Enter a whole number for service encounters involving drug checking for each zip code provided. When the zip code is "unknown" total the remaining encounters with drug checking and enter a whole number. | |
| HR_Naloxone | ||
| Total_Naloxone_Distributed | Enter a whole number for pre-measured doses of naloxone distributed by an OD2A-S funded or supported organization during the designated reporting period. | |
| Type_of_Organization | This variable has been pre-selected. If data are not available for a particular type of organization, enter 0 for all variables in the adjacent row. | |
| Num_Doses_Distributed | Enter a whole number for the count of all pre-measured naloxone doses distributed for each type of organization. | |
| ZipCode_By_Nal_Distribution_Site | Enter the five-digit zip code where the funded organization distributed their doses of naloxone. For any distribution site where the zip code is unknown, provide the total in the adjacent cell. | |
| Num_Doses_Distributed_ZipCode | Enter a whole number for the count of pre-measured naloxone doses distributed for each zip code. When the zip code is "unknown" total the remaining doses distributed and enter a whole number. | |
| LTC_Navigators | ||
| Total_Navigators | Enter a total count of unique navigators who link PWUD to care and/or harm reduction services via warm handoffs during the designated reporting period. | |
| Nav_Clinical | Enter a whole number for the navigators located in a health/clinical setting. | |
| Nav_HR | Enter a whole number for the located in a harm reduction setting. | |
| Nav_Public_Safety | Enter a whole number for the navigators located in a public safety setting. | |
| Nav_Other | Enter a whole number for the in any other settings. | |
| Navigator_Hours_Clinical | This disaggregate is optional. If chosen, enter a whole number for the total hours navigators have spent on linkage to care or referral efforts in health/clinical settings. | |
| Navigator_Hours_HR | This disaggregate is optional. If chosen, enter a whole number for the total hours navigators have spent on linkage to care or referral efforts in harm reduction settings. | |
| Navigator_Hours_Public_Safety | This disaggregate is optional. If chosen, enter a whole number for the total hours navigators have spent on linkage to care or referral efforts in public safety settings. | |
| Navigator_Hours_Other | This disaggregate is optional. If chosen, enter a whole number for the total hours navigators have spent on linkage to care or referral efforts in any other settings. | |
| LTC_Referrals | ||
| Total_Referrals | This is a formula field that will generate a total count of unique referrals to care and harm reduction services once the disaggregates below are entered in the appropriate fields. | |
| Race_Ethnicity | This variable has been pre-selected. If data are not available for a particular race and ethnicity, enter 0 for all variables in the adjacent row. Note: when the race_ethnicity is marked unknown, this also includes if an individual preferred not to answer. | |
| Ref_MOUD | Enter a whole number for all referrals to MOUD for each race/ethnicity with available data. | |
| Ref_Behavioral_Trt | Enter a whole number for all referrals to behavioral health treatment only (without MOUD) for each race/ethnicity with available data. | |
| Ref_to_HR | Enter a whole number for all referrals to harm reduction services for each race/ethnicity with available data. | |
| Total_Ref_Race_Ethnicity | This is a formula field that will generate a total count for all referrals to MOUD, behavioral treatment only (without MOUD), and harm reduction services by each race/ethnicity. | |
| HS_Training | ||
| Total_Trained | Enter a whole number for the count of all unique clinicians trained on implementing the 2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain during the designated reporting period. | |
| Specialty | This disaggregate is optional. If chosen, select a specialty from the dropdown list for the type of clinicians trained on the 2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain. | |
| Num_Trained | This disaggregate is optional. If chosen, enter a whole number for the unique clinicians by specialty who are trained on implementing the 2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain. | |
| Num_Eligible | This disaggregate is optional. If chosen, enter a whole number for all eligible clinicians who could be trained on implementing the 2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain. | |
| Percent_Clinician_Trained | This disaggregate is optional. It is a formula field that will generate a percentage of clinicians trained when the numerator (Num_Trained) and denominator (Num_Eligible) are entered into the appropriate fields. | |
| HS_SUD_Protocols | ||
| Total_Health_Settings | Enter the total count of health/clinical settings where protocols and/or policies have been implemented/improved for evidence-based SUD treatment and/or referrals. Note this will be the number of unique health settings, regardless of whether they have just one or both types of protocols/policies. | |
| Num_Settings_SUD_Treatment | Enter a whole number for the health/clinical settings where protocols or policies have been implemented/improved for evidence-based SUD treatment. | |
| Num_Settings_SUD_Referrals | Enter a whole number for the health/clinical settings where protocols or policies have been implemented/improved for evidence-based SUD referrals. |
HE_Activities
| Number of health equity focused overdose prevention activities implemented with OD2A funding |
| Data Entry Instructions |
| Total_HE_Activities: This is a formula field that will generate a total count of health equity focused overdose prevention activities that occurred in a clinical, harm reduction, public safety, or other settings during the designated reporting period once the disaggregates below are entered into the appropriate fields. |
HE_Clinical_Settings: Enter a whole number for the health equity focused overdose prevention activities that occurred in a health/clinical setting.
HE_HR_Settings: Enter a whole number that reflects the health equity focused overdose prevention activities that occurred in a harm reduction setting.
HE_Public_Safety_Settings: Enter a whole number that reflects the health equity focused overdose prevention activities that occurred in a public safety setting.
HE_Other_Settings: This disaggregate is optional. If chosen, enter a whole number that reflects the health equity focused overdose prevention activities that occurred in any setting outside of clinical, harm reduction, and public safety.
Please note that CDC is requesting that jurisdictions enter all counts—please do not suppress small numbers. If the count is zero, please enter “0”—please do not leave these cells null or blank to ensure these cells are not mischaracterized as missing data.
Required Total_HE_Activities 0
| DISAGGREGATES | |||||
| Required | Required | Required | Optional | ||
| Jurisdiction | Reporting_Period | HE_Clinical_Settings | HE_HR_Settings | HE_Public _Safety_ Settings | HE_Other_Settings |
| 0 | 0 |
HR_Encounters
| Number of harm reduction service encounters at OD2A funded or supported organizations |
| Data Entry Instructions |
| Total_HR_Encounters:Enter a total count of harm reduction service encounters (e.g., in-person, mail, telephone, online) that occurred at an OD2A-S funded or supported organization during the designated reporting period. |
Encounters_with_Drug_Checking: Enter a whole number for service encounters where in-person drug checking occurred.
ZipCode_By_HR_Service _Site: Enter the five-digit zip code for each site where harm reduction services (e.g., in-person, mail, telephone, online) were provided. For any service site where services are provided in person, use the brick and mortar location zip code. For services provided via phone or mail, use the address of the brick and mortar location. For mobile-based outreach services, use the zip code of outreach. For any service sites where zip codes are unknown, provide the total number of encounters that occurred across locations with unknown zip codes in the designated cell for “unknown” within the adjacent cell.
Encounters_with_Drug_Checking_by_ZipCode: Enter a whole number for service encounters involving drug checking for each zip code provided. When the zip code is "unknown" total the remaining encounters with drug checking and enter a whole number.
Please note that CDC is requesting that jurisdictions enter all counts—please do not suppress small numbers. If the count is zero, please enter “0”—please do not leave these cells null or blank to ensure these cells are not mischaracterized as missing data.
Required Total_HR_Encounters
| DISAGGREGATE | ||
| Required | ||
| Jurisdiction | Reporting_Period | Encounters_with_Drug_Checking |
| 0 | 0 |
| DISAGGREGATES | |
| Required | Required |
| ZipCode_By_HR_Service_Site | Encounters_with_Drug_Checking_by_ZipCode |
| Subtotal | 0 |
| Unknown |
HR_Naloxone
| Number of naloxone doses distributed by OD2A funded or supported organizations |
| Data Entry Instructions |
| Total_Naloxone_Distributed: Enter a whole number for pre-measured doses of naloxone distributed by an OD2A-S funded or supported organization during the designated reporting period. |
Type_of_Organization: This variable has been pre-selected. If data are not available for a particular type of organization, enter 0 for all variables in the adjacent row.
Num_Doses_Distributed: Enter a whole number for the count of all pre-measured naloxone doses distributed for each type of organization.
ZipCode_By_Nal_Distribution_Site: Enter the five-digit zip code where the funded organization distributed their doses of naloxone. For any distribution site where the zip code is unknown, provide the total in the adjacent cell.
Num_Doses_Distributed_ZipCode: Enter a whole number for the count of pre-measured naloxone doses distributed for each zip code. When the zip code is "unknown" total the remaining doses distributed and enter a whole number.
Please note that CDC is requesting that jurisdictions enter all counts—please do not suppress small numbers. If the count is zero, please enter “0”—please do not leave these cells null or blank to ensure these cells are not mischaracterized as missing data.
Required Total_Naloxone_Distributed
| DISAGGREGATES | |||
| Required | Required | ||
| Jurisdiction | Reporting_Period | Type_of_Organization | Num_Doses_Distributed |
| 0 | 0 | Syringe Service Programs | |
| 0 | 0 | Community-based organizations | |
| 0 | 0 | Senior care organizations | |
| 0 | 0 | Faith-based organizations | |
| 0 | 0 | Emergency Department/Urgent Care | |
| 0 | 0 | Other healthcare organizations | |
| 0 | 0 | Police departments | |
| 0 | 0 | Jails/Prisons | |
| 0 | 0 | Colleges/Universities | |
| 0 | 0 | Secondary education | |
| 0 | 0 | Other Health Department | |
| 0 | 0 | Other | |
| Subtotal | 0 |
| DISAGGREGATES | |
| Required | Required |
| ZipCode_By_Nal_Distribution_Site | Num_Doses_Distributed_ZipCode |
| Subtotal | 0 |
| Unknown |
LTC_Navigators
| Number of navigators who link PWUD to care and harm reduction services via warm handoffs |
| Data Entry Instructions |
| Total_Navigators: Enter a total count of unique navigators who link PWUD to care and/or harm reduction services via warm handoffs during the designated reporting period. |
Nav_Clinical: Enter a whole number for the navigators located in a health/clinical setting.
Nav_HR: Enter a whole number for the navigators located in a harm reduction setting.
Nav_Public_Safety: Enter a whole number for the navigators located in a public safety setting.
Nav_Other: Enter a whole number for the navigators in any other settings.
Navigators_Hours_Clinical: This disaggregate is optional. If chosen, enter a whole number for the total hours navigators have spent on linkage to care or referral efforts in health/clinical settings.
Navigators_Hours_HR: This disaggregate is optional. If chosen, enter a whole number for the total hours navigators have spent on linkage to care or referral efforts in harm reduction settings.
Navigators_Hours_Public_Safety: This disaggregate is optional. If chosen, enter a whole number for the total hours navigators have spent on linkage to care or referral efforts in public safety settings.
Navigators_Hours_Other: This disaggregate is optional. If chosen, enter a whole number for the total hours navigators have spent on linkage to care or referral efforts in any other settings.
Please note that CDC is requesting that jurisdictions enter all counts—please do not suppress small numbers. If the count is zero, please enter “0”—please do not leave these cells null or blank to ensure these cells are not mischaracterized as missing data.
Required Total_Navigators
| DISAGGREGATES | |||||||||
| Required | Required | Required | Optional | Optional | Optional | Optional | Optional | ||
| Jurisdiction | Reporting_Period | Nav_Clinical | Nav_HR | Nav_Public_Safety | Nav_Other | Navigators_Hours_Clinical | Navigators_Hours_HR | Navigators_Hours_Public_Safety | Navigators_Hours_Other |
| 0 | 0 |
LTC_Referrals
| Number of referrals to care and harm reduction services |
| Data Entry Instructions |
| Total_Referrals: This is a formula field that will generate a total count of unique referrals to care and harm reduction services once the disaggregates below are entered in the appropriate fields. |
Race_Ethnicity: This variable has been pre-selected. If data are not available for a particular race and ethnicity, enter 0 for all variables in the adjacent row. Note: when the race_ethnicity is marked unknown, this also includes if an individual preferred not to answer.
Ref_MOUD: Enter a whole number for all referrals to MOUD for each race/ethnicity with available data.
Ref_Behavioral_Trt: Enter a whole number for all referrals to behavioral health treatment only (without MOUD) for each race/ethnicity with available data.
Ref_to_HR: Enter a whole number for all referrals to harm reduction services for each race/ethnicity with available data.
Total_Ref_Race_Ethnicity: This is a formula field that will generate a total count for all referrals to MOUD, behavioral treatment only (without MOUD), and harm reduction services by each race/ethnicity.
Please note that CDC is requesting that jurisdictions enter all counts—please do not suppress small numbers. If the count is zero, please enter “0”—please do not leave these cells null or blank to ensure these cells are not mischaracterized as missing data.
Required Total_Referrals 0
| DISAGGREGATES | ||||||
| Required | Required | Required | Required | Required | ||
| Jurisdiction | Reporting_Period | Race_Ethnicity | Ref_MOUD | Ref_Behavioral_Trt | Ref_to_HR | Total_Ref_Race_Ethnicity |
| 0 | 0 | American Indian or Alaska Native | 0 | |||
| 0 | 0 | Asian | 0 | |||
| 0 | 0 | Black or African American | 0 | |||
| 0 | 0 | Hispanic or Latino | 0 | |||
| 0 | 0 | Middle Eastern or North African | 0 | |||
| 0 | 0 | Native Hawaiian or Other Pacific Islander | 0 | |||
| 0 | 0 | White | 0 | |||
| 0 | 0 | Multiracial and/or Multiethnic | 0 | |||
| 0 | 0 | Unknown | 0 | |||
| Subtotal | 0 | 0 | 0 | 0 |
HS_Training
| Number of clinicians who received training on implementing the "2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain" |
| Data Entry Instructions |
| Total_Trained: Enter a whole number for the count of all unique clinicians trained on implementing the 2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain during the designated reporting period. |
Specialty: This disaggregate is optional. If chosen, select a specialty from the dropdown list for the type of clinicians trained on the 2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain.
Num_Trained: This disaggregate is optional. If chosen, enter a whole number for the unique clinicians by specialty who are trained on implementing the 2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain.
Num_Eligible: This disaggregate is optional. If chosen, enter a whole number for all eligible clinicians who could be trained on implementing the 2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain.
Percent_Clinician_Trained: This disaggregate is optional. It is a formula field that will generate a percentage of clinicians trained when the numerator (Num_Trained) and denominator (Num_Eligible) are entered into the appropriate fields.
Please note that CDC is requesting that jurisdictions enter all counts—please do not suppress small numbers. If the count is zero, please enter “0”—please do not leave these cells null or blank to ensure these cells are not mischaracterized as missing data.
Required Total_Trained
| DISAGGREGATES | |||||
| Optional | Optional | Optional | Optional | ||
| Jurisdiction | Reporting_Period | Specialty | Num_Trained | Num_Eligible | Percent_Clinician_Trained |
| 0 | 0 | ||||
| 0 | 0 | ||||
| 0 | 0 | ||||
| 0 | 0 | ||||
| 0 | 0 | ||||
| 0 | 0 | ||||
| 0 | 0 | ||||
| 0 | 0 | ||||
| 0 | 0 | ||||
| Subtotal | 0 | 0 |
HS_SUD_Protocols
| Number of health/clinical settings implementing or improving protocols and/or policies for evidence-based SUD treatment or referrals |
| Data Entry Instructions |
| Total_Health_Settings: Enter the total count of health/clinical settings where protocols and/or policies have been implemented/improved for evidence-based SUD treatment and/or referrals. Note this will be the number of unique health settings, regardless of whether they have just one or both types of protocols/policies. |
Num_Settings_SUD_Treatment: Enter a whole number for the health/clinical settings where protocols or policies have been implemented/improved for evidence-based SUD treatment.
Num_Settings_SUD_Referrals: Enter a whole number for the health/clinical settings where protocols or policies have been implemented/improved for evidence-based SUD referrals.
Please note that CDC is requesting that jurisdictions enter all counts—please do not suppress small numbers. If the count is zero, please enter “0”—please do not leave these cells null or blank to ensure these cells are not mischaracterized as missing data.
Required Total_Health_Settings
| DISAGGREGATES | |||
| Required | Required | ||
| Jurisdiction | Reporting_Period | Num_Settings_SUD_Treatment | Num_Settings_SUD_Referrals |
| 0 | 0 |
HE_Partners Partners with employees with lived/living experiences tc={A7E277C7-752A-492F-950C-CF9360442CDE}: [Threaded comment]
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Comment:
@Bolton, Jourdan A (CDC/NCIPC/DOP) looks like #s are missing here.
Please answer the following contextual questions.
1. Is there anything you want to share that would help contextualize your response?
tc={847E71A7-F2E9-4FA6-82B5-85136468DE7F}: [Threaded comment]
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Comment:
@Bolton, Jourdan A (CDC/NCIPC/DOP) see IRS to update contextual questions.
Describe and provide metadata on this report of partnering organizations.
1. Describe any issues or concerns that impact the quality of the data shared (e.g., data completeness, data accuracy, facilitators/barriers for collection and reporting).
Lists
| Race | Jurisdiction | Time Period | Type of organization | Specialty |
| American Indian or Alaska Native | Alabama | 3/1/2024-8/31/2024 | Syringe Service Programs | Primary care |
| Asian | Alaska | 9/1/2024-8/31/2025 | Community-based organizations | Emergency medicine |
| Black or African American | Arizona | 9/1/2025-8/31/2026 | Senior care organizations | Hospitalists |
| Hispanic or Latino | Arkansas | 9/1/2026-8/31/2027 | Faith-based organizations | Surgeons |
| Middle Eastern or North African | California | 9/1/2027-3/31/2028 | Emergency Department/Urgent Care | OB/GYNs |
| Native Hawaiian or Other Pacific Islander | Colorado | Other healthcare organizations | Neurologists | |
| White | Connecticut | Police departments | Dentists | |
| Multiracial and/or Multiethnic | D.C. Washington | Jails/Prisons | Physical medicine and rehabilitation | |
| Unknown | Delaware | Colleges/Universities | Occupational medicine | |
| Florida | Secondary education | Pharmacists | ||
| Georgia | Other Health Department | Other | ||
| Hawaii | Other | |||
| Idaho | ||||
| Illinois | ||||
| Indiana | ||||
| Iowa | ||||
| Kansas | ||||
| Kentucky | ||||
| Louisiana | ||||
| Maine | ||||
| Maryland | ||||
| Massachusetts | ||||
| Michigan | ||||
| Minnesota | ||||
| Mississippi | ||||
| Missouri | ||||
| Montana | ||||
| Nebraska | ||||
| Nevada | ||||
| New Hampshire | ||||
| New Jersey | ||||
| New Mexico | ||||
| New York | ||||
| North Carolina | ||||
| Ohio | ||||
| Oklahoma | ||||
| Oregon | ||||
| Pennsylvania | ||||
| Rhode Island | ||||
| South Carolina | ||||
| South Dakota | ||||
| Tennessee | ||||
| Texas | ||||
| Utah | ||||
| Vermont | ||||
| Virginia | ||||
| Washington | ||||
| West Virginia | ||||
| Wyoming |
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