0920-1233 Coverdell Cost Collection Tool

---

Overview

Introduction
0_Project
1_Personnel
2_Contracts
3_Equipment
4_Indirect
5_InKind_Labor
6_InKind_NonLabor

---

Sheet 1: Introduction

[Enter Site Name Here]
Coverdell Cost Collection Tool (CCT)
Introduction
Thank you for participating in the Coverdell cost study. We are researchers from Research Triangle Institute (RTI), International evaluating the Paul Coverdell National Acute Stroke Registry Program on behalf of the Centers for Disease Control and Prevention. This data collection effort will provide important information about the costs necessary for program implementation. Your decision to participate is voluntary. If you do not wish to participate in this cost study, please let us know. We believe there are minimal risks to you from participation, and every effort will be made to protect your confidentiality. We assure you that you will not be quoted by name. To support ongoing program improvements, we will share de-identified cost data with CDC and summarize findings in reports. For any questions regarding the study, please contact Naomi Buell at nbuell@rti.org. You can navigate the Cost Collection Tool (CCT) using the tabs at the bottom of the spreadsheet or the buttons for each section below. Each section has instructions and help popups to assist you in completing the tool. For additional technical assistance, please contact Naomi Buell at nbuell@rti.org.
In this cost data collection instrument, we ask that you report costs for each of six resource categories:
1. Personnel
2. Contracts & Consultants
3. Equipment, Supplies & Materials, Travel, & Other Services
4. Indirect/Overhead costs
5. In-kind Labor costs
6. In-kind Non-Labor costs
For each cost category you are asked to allocate how costs were divided across the Coverdell strategies your program is implementing (as stated in your workplan), in addition to Evaluation and Administrative costs.
The 9 Coverdell Strategies are:
(1) EHR/Health IT
(2) Data Management
(3) Referral Tracking
(4) Quality Improvement
(5) Workforce Development
(6) Patient Care Practices
(7) Establish and strengthen partnerships
(8) Patient Navigators/CHWs
(9) Educational Messaging
You need only to provide cost allocations for the strategies your program is working on. Full strategy descriptions are included on the '0_Project' tab, and by clicking on the Strategy titles in each column throughout the workbook.
We also ask that you estimate project-level effort across strategies, by populations reached (high risk and general), and by setting (pre-hospital, in-hospital, post-hospital, and other). Community efforts should be reported under the 'Other' setting. Level of effort estimates should consider all potential cost categories.
Please report only costs for the following reporting period
Reporting Period:
How to Navigate the Cost Data Collection Tool:
Data on Personnel is entered on the tab, 1_Personnel, or by clicking the button to the right.
Data on contracted services and consultants is entered on the tab, 2_Contracts, or by clicking the button to the right.
Data on equipment and supplies is entered on the tab, 3_Equipment, or by clicking the button to the right.
Data on indirect/overhead costs is entered on the tab, 4_Indirect, or by clicking the button to the right.
Data on in-kind labor costs is entered on the tab, 5_InKind_Labor or by clicking the button to the right.
Data on in-kind non-labor costs is entered on the tab, 6_InKind_NonLabor or by clicking the button to the right.

---

Sheet 2: 0_Project

Project Level
Instructions: On this screen you are asked to estimate program-wide level of effort by populations reached and by setting for each Coverdell strategy. For example, estimate the % of programmatic wide effort on Educational Messaging (Strategy 9) specifically targeted to populations at highest risk of stroke events in each setting, and the % of efforts spent on educational messaging activities intended to reach the general population in each setting. Consider all potential cost categories when estimating effort (including labor costs, contracts, supplies and equipment, and in-kind contributions). The sum of the whole row should equal 100% for each strategy being implemented. For additional technical assistance, please contact Naomi Buell at nbuell@rti.org.
Report only costs for the following reporting period:
Reporting Period:
		Level of Effort (%) by Populations Reached											1500
Strategy	Strategy Description	% Effort Targeted to High Risk Populations					% Effort Reaching General Population					Percent Effort Totals Check
		Pre-Hospital	In-Hospital	Post-Hospital	Other Setting	Total	Pre-Hospital	In-Hospital	Post-Hospital	Other Setting	Total
C.1 - EHR/Health IT	Strategy C.1 Leverage electronic health records (EHRs) and health information technology (HIT) to identify patients with stroke risk factors (e.g. undiagnosed hypertension)and monitor health care disparities for those at highest risk for stroke events.					0.0					0.0	0
C.2 - Data Management	Strategy C.2 Establish and expand state-wide data infrastructure through an integrated data management system that links pre-hospital, hospital, and post-hospital follow up data for measurement, tracking, and assessment of quality of stroke care data.					0.0					0.0	0
C.3 - Referral Tracking	Strategy C.3 Coordinate the development and implementation of a referral tracking system to support transitions of care for stroke patients post-discharge.				0.0					0.0	0
C.4 - Quality Improvement	Strategy C.4 Analyze data and identify areas to improve the efficiency and quality of care within EMS and hospital settings and to improve transitions of care between settings through systematic Quality Improvement (QI) methods and interventions (e.g. PDSA, Lean, Six Sigma).				0.0					0.0	0
C.5 - Workforce Development	Strategy C.5 Coordinate, develop, and implement professional and work force development opportunities (e.g. training, technical assistance, peer to peer learning, continuing education, workshops, etc.)to improve evidence-based clinical knowledge for stroke care, recognition of disparities in stroke care, and implementation of activities to address them (e.g. unconscious bias training, clinical decision-making tools, cultural competence).				0.0					0.0	0
C.6 - Patient Care Practices	Strategy C.6 Develop and implement patient care practices/patient care protocols within EMS and hospital systems to coordinate patient hand-off and transitions in care throughout the stroke systems of care.				0.0					0.0	0
C.7 - Establish & strengthen partnerships	Strategy C.7 Establish and strengthen partnerships with relevant state or local stroke coalitions, initiatives, professional organizations, providers, and health systems that provide resource support for stroke patients, as well as those at highest risk for stroke events.				0.0					0.0	0
C.8 - Patient Navigators/CHWs	Strategy C.8 Facilitate engagement of patient navigators/community health workers in the management of those at highest risk for stroke events and post-event discharge support and follow-up of stroke patients across clinical and community settings.				0.0					0.0	0
C.9 - Educational Messaging	Strategy C.9 Coordinate and/or promote stroke messaging/education within communities and clinical settings around the importance of addressing the needs of those at highest risk for stroke events and the appropriate response during a stroke event, including utilizing EMS for stroke transport.				0.0					0.0	0

---

Sheet 3: 1_Personnel

Personnel Costs
Instructions: On this screen you are asked to enter salaries (including fringe) of all staff members working on Coverdell, how many months they have been working on Coverdell in the reporting period, and information on their level of effort on Coverdell strategies. Consultants are not included in this section; they are counted in another section. All entered percentages must add to 100% across the row. The percentage check cell on the far right of the table will update as you enter percent allocations. Help information is available for each data element by clicking on the data element title in each column. For additional technical assistance, please contact Naomi Buell at nbuell@rti.org.
Report only costs for the following reporting period:
Reporting Period:
				% of Coverdell Time Spent on Specific Strategies
Job Title	Salary and Fringe	Months Worked on Coverdell During the Reporting Period	% Time Spent on Coverdell Activities	C.1 - EHR/Health IT	C.2 - Data Management	C.3 - Referral Tracking	C.4 - Quality Improvement	C.5 - Workforce Development	C.6 - Patient Care Practices	C.7 - Establish & Strengthen Partnerships	C.8 - Patient Navigators/CHWs	C.9 - Educational Messaging	Evaluation	Administration	Percent Totals Check
														0
														0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
	Enter Comments Here (optional):

---

Sheet 4: 2_Contracts

Contracts & Consultants
Report only costs for the following reporting period:
Reporting Period:
			% of Coverdell Usage Spent on Specific Strategies
Description	Total Cost		C.1 - EHR/Health IT	C.2 - Data Management	C.3 - Referral Tracking	C.4 - Quality Improvement	C.5 - Workforce Development	C.6 - Patient Care Practices	C.7 - Establish & Strengthen Partnerships	C.8 - Patient Navigators/CHWs	C.9 - Educational Messaging	Evaluation	Administration	Percent Totals Check
														0
														0
														0
														0
														0
														0
														0
														0
														0
														0
														0
														0
														0
														0
														0
														0
														0
														0
														0
		Enter Comments Here:

---

Sheet 5: 3_Equipment

Equipment, Supplies & Materials, Travel & Other Services
Report only costs for the following reporting period:
Reporting Period:
Item Description				% of Coverdell Usage Spent on Specific Strategies
Date of Expenditure	Description	Total Cost	% of Resource Used for Coverdell Activities	C.1 - EHR/Health IT	C.2 - Data Management	C.3 - Referral Tracking	C.4 - Quality Improvement	C.5 - Workforce Development	C.6 - Patient Care Practices	C.7 - Establish & Strengthen Partnerships	C.8 - Patient Navigators/CHWs	C.9 - Educational Messaging	(6) Evaluation	7) Administration	Percent Totals Check
															0
															0
															0
															0
															0
															0
															0
															0
															0
															0
															0
															0
															0
															0
															0
															0
															0
															0
															0
	Enter Comments Here:

---

Sheet 6: 4_Indirect

Indirect/Overhead Costs
Instructions: In the table below, please record information for overhead costs spent on activities for the Coverdell Program. Organizations typically have a specific method for allocating overhead costs, so please select the method your orgnization uses and provide details. For additional technical assistance, please contact Naomi Buell at nbuell@rti.org.
Report only costs for the following reporting period:
Reporting Period:
1. What is the total administrative/overhead costs of the Coverdell program in this period?
2. What indirect cost allocation methodology was used to generate the admin/overhead cost?
Indirect/Overhead Cost Methodology	Selection
Fixed Dollar ($) Amount	Yes
Pecentage of Direct Cost	No	Enter Percentage
Other	No	Please specify
List any additional administrative or infrastructure costs below that are not included in the total overhead costs provided above.
Item Description	Total Cost	Percent Used for Coverdell

---

Sheet 7: 5_InKind_Labor

In-Kind Labor/Personnel Costs
Instructions: On this screen you're asked to enter information on staff that contributed time to the Coverdell program, but were not paid out of the Coverdell budget. You are also asked to provide information on time spent on Coverdell strategies. The percent time on all strategies should sum to 100% for each person. Help information is available for each data element by clicking on the data element title in each column. For additional technical assistance, please contact Naomi Buell at nbuell@rti.org.
Report only costs for the following reporting period:
Reporting Period:
			% of Coverdell Hours Spent on Specific Strategies
			C.1 - EHR/Health IT	C.2 - Data Management	C.3 - Referral Tracking	C.4 - Quality Improvement	C.5 - Workforce Development	C.6 - Patient Care Practices	C.7 - Establish & Strengthen Partnerships	C.8 - Patient Navigators/CHWs	C.9 - Educational Messaging	Evaluation	Administration	Percent Totals Check
														0
														0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
		Enter Comments Here:

---

Sheet 8: 6_InKind_NonLabor

In-Kind Non-Labor
Instructions: On this screen you're asked to enter information on non-labor items used in the Coverdell program, but were not paid out of the Coverdell budget. You are also asked to provide information about their use on Coverdell activities. The percent time on all activities should sum to 100% for each row. Help information is available for each data element by clicking on the data element title in each column. For additional technical assistance, please contact Naomi Buell at nbuell@rti.org.
Report only costs for the following reporting period:
Reporting Period:
			% of Coverdell Usage Spent on Specific Strategies
			C.1 - EHR/Health IT	C.2 - Data Management	C.3 - Referral Tracking	C.4 - Quality Improvement	C.5 - Workforce Development	C.6 - Patient Care Practices	C.7 - Establish & Strengthen Partnerships	C.8 - Patient Navigators/CHWs	C.9 - Educational Messaging	(6) Evaluation	(7) Administration	Percent Totals Check
														0
														0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
													0
		Enter Comments Here: