Form Grantee-Level Outc Grantee-Level Outc Grantee-Level Outcomes

Strategic Prevention Framework for Prescription Drugs (SPF-Rx)

Attachment_3_SPF-Rx Grantee-Level Outcomes_Module_OMB_06_19_17

Grantee-Level Outcomes Module

OMB: 0930-0377

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Program Evaluation
for Prevention:
SPF-Rx
Grantee-Level Outcomes Module

Contents
Section

Page

Information and Directions

Opioid Overdose Morbidity and Mortality
1.1

Hospital Data for Opioid Overdoses

1.2

Other Opioid Overdose Events (for Approved Substitute Data Source)

1.3

Opioid Overdose Deaths

Opioid Prescribing Patterns and Prescriber Use of PDMP

2.1

Opioid Prescribing Patterns (PDMP Data)

2.2

Prescriber Use of PDMP (PDMP data)

Consumption: Survey Estimates of Prescription Drug Misuse and Abuse

3.1

Targeted Outcome Measure of Consumption/Prescription Drug Misuse

3.2

Survey Information and Results

Information and Directions
The Grantee-Level Outcomes Module collects outcome data annually from SPF-Rx
grantees. Grantees will report outcome data for the subrecipient communities in the
Community-Level Outcomes Module.
Grantee is used to indicate the state/tribal entity/jurisdiction receiving the award
from the Substance Abuse and Mental Health Administration (SAMHSA). Note that
grantee-level data refers to the entire state (or tribal area or jurisdiction). It does not
refer to the aggregate of the funded communities.
Data submission deadlines are November 15 of each year. Report data for the prior
calendar year. You will also be asked to provide baseline data for 2 years prior to the
start of the grant, if available.
The Outcome Requirements at a Glance provides a summary of the reporting
requirements. See the Outcomes Module Guidance Manual for more detailed
instructions on how to report data and complete this module.
This module is divided into three main sections for reporting key SPF-Rx outcomes:
1. Opioid overdose morbidity and mortality (hospital and vital statistics data);
2. Opioid prescribing patterns and prescriber use of Prescription Drug Monitoring
Program (PDMP data); and
3. Consumption: Prescription drug misuse and abuse (survey data).

1. Opioid Overdose Morbidity and
Mortality
Use this section to report annual numbers of opioid-related overdoses and
overdose deaths at the grantee level. You will report data on these outcomes in two
ways. First, provide the data aggregated for all types of opioids except heroin.
Second, provide the data for heroin separately. (The relevant ICD-10 codes are
provided in the instruction manual.) If you cannot report the data broken out this
way, please explain in the Data Comments section below.

1.1 Hospital Data for Opioid Overdoses
Grantees are required to report data on emergency department visits involving
opioid overdose. If emergency department data are not available, please provide
hospital admissions data. If no hospital data are available, submit a substitute data
request for alternative overdose data you may have (e.g., emergency medical service
data).
Report data by age group and sex. If you cannot obtain outcomes by age and sex,
provide an explanation after the table. If feasible, please provide information on
ethnicity and race.
State grantees do not need to report information in the Population (Denominator)
field, as these data will be pulled from the Centers for Disease Control and
Prevention’s (CDC’s) WONDER database. Tribal and nonstate jurisdiction grantees
are asked to provide the total number of residents for the Population (Denominator)
field.

Data Source Time Frame (Start Date and End Date)
Indicate the time frame during which data for this measure were collected. Enter the
start date and end date for the time period of the data you are submitting.
Start Date: ________________________________(month/day/year)
End Date: _________________________________(month/day/year)
Types of Opioid
For which types of opioid are you submitting data now? (You are asked to provide
data for all opioids except for heroin, and then separately for heroin.) If you cannot
provide the data broken out as requested, choose “other,” and specify the types of
opioids that are included in your data. Provide any additional relevant information
about the data in the Data Comments section below. (Select One)
All opioids except for heroin
Heroin
Other (Specify types of opioids that are included:_____________________________)
Other (Specify types of opioids that are included:_____________________________)

Hospital Data for Opioid Overdoses

Demographic
Group

Emergency
Total
Department
Emergency Hospitalizations
Visits Involving
Department
Involving
Total
Population
Opioid
Visits
Opioid
Hospitalizations
(Denominator)
Overdose
(Denominator)
Overdose
(Denominator)

Total
Total

Numerical

<18 yr

Numerical

18–24 yr

Numerical

65+

Numerical

Unavailable

Numerical

Male

Numerical

Female

Numerical

Other

Numerical

Unavailable

Numerical

By age

25–34 yr
35–44 yr
45–54 yr
55–64 yr

State grantees
do not need to
provide
population data,
as they will be
pulled from
CDC WONDER

Sex

By ethnicity (if available)
Hispanic or
Latino
Not Hispanic or
Latino
Unavailable
By race (if available)
State grantees
do not need to
Black or African
provide
American
population data,
Asian
as they will be
White

Emergency
Total
Department
Emergency Hospitalizations
Visits Involving
Department
Involving
Total
Opioid
Visits
Opioid
Hospitalizations
Demographic
Population
Group
(Denominator)
Overdose
(Denominator)
Overdose
(Denominator)
pulled
from
CDC
Native Hawaiian
WONDER
or Other Pacific
Numerical
Numerical
Numerical
Numerical
Islander
American Indian
or Alaska Native

Numerical

Two or more
races

Numerical

Unavailable

Numerical

Data Source(s): List all data sources for your data.
___________________________________________________________________________________________
Data Comments
Please provide any additional information about the data source(s) or any other
information that would be useful in understanding the overdose data you have
provided.
Data

Additional Information

Population

Free text

Emergency Department Visits Involving Opioid Overdose

Free text

Hospitalizations Involving Opioid Overdose

Free text

1.2 Other Opioid Overdose Events (for Approved Substitute
Data Source)
This is where you report any alternative opioid overdose data if you do not have
access to hospital data. First, you would need to submit a substitute data source
request and get it approved.
Substitute Date Source
[Dropdown box that lists all the approved Substitute Data Source Requests for this
grantee]
Data Source Time Frame (Start Date and End Date)
Indicate the time frame during which data for this measure were collected. Enter the
start date and end date for the time period of the data you are submitting.
Start Date: ________________________________(month/day/year)
End Date: _________________________________(month/day/year)
Types of Opioid
For which types of opioid are you submitting data now? (You are asked to provide
data for all opioids except for heroin, and then separately for heroin.) If you cannot
provide the data broken out as requested, choose “other,” and specify the types of
opioids that are included in your data. Provide any additional relevant information
about the data in the Data Comments section below. (Select One)
All opioids except for heroin
Heroin
Other (Specify types of opioids that are included:_____________________________)
Other (Specify types of opioids that are included:_____________________________)

Other Opioid Overdose Events (for Approved Substitute Data Source)
Other Opioid
Overdose Events
(optional)

Total Number of
Events
(Denominator)

Numerical

<18 yr

Numerical

18–24 yr

Numerical

Male

Numerical

Female

Numerical

Other

Numerical

Unavailable

Numerical

Population
(Denominator)

Demographic
Group
Total
Total
By age

25–34 yr
35–44 yr
45–54 yr
55–64 yr

State grantees
do not need to
provide
population data,
as they will be
pulled from CDC
WONDER

65+ yr
Unavailable
By sex

Data Comments
Please provide any additional information about the data source or other
information that would be useful in understanding the overdose data you have
provided.
Data

Additional Information

Population

Free text

Other Opioid Overdose Events

Free text

1.3 Opioid Overdose Deaths
In this section, grantees that are tribes or nonstate jurisdictions report data on
opioid overdose deaths. State grantees do not need to report opioid overdose deaths
because these data will be pulled from CDC’s WONDER database.
Data Source Time Frame (Start Date and End Date)
Indicate the time frame during which data for this measure were collected. Enter the
start date and end date for the time period of the data you are submitting.
Start Date: ________________________________(month/day/year)
End Date: _________________________________(month/day/year)
Types of Opioid
For which types of opioid are you submitting data now? (You are asked to provide
data for all opioids except for heroin, and then separately for heroin.) If you cannot
provide the data broken out as requested, choose “other,” and specify the types of
opioids that are included in your data. Provide any additional relevant information
about the data in the Data Comments section below. (Select One)
All opioids excluding heroin
Heroin
Other (Specify types of opioids that are included:_____________________________)
Other (Specify types of opioids that are included:_____________________________)
In the table below, provide the number of opioid deaths by age and gender. If you
cannot obtain outcomes by age and gender, provide an explanation after the table.

Opioid Overdose Deaths
Demographic
Group

Population
(Denominator)

Opioid Overdose
Deaths

Total Deaths

Total
Total

State grantees do not need to provide these data, as they will be
pulled from CDC WONDER

By age
<18 yr
18–24 yr
25–34 yr
35–44 yr

State grantees do not need to provide these data, as they will be
pulled from CDC WONDER

45–54 yr
55–64 yr
65+ yr
Unavailable
By sex
Male
Female

State grantees do not need to provide these data, as they will be
pulled from CDC WONDER

Other
Unavailable

Data Source(s): List all data sources for your data.
___________________________________________________________________________________________
Data Comments
Please any additional provide information about the data source or other
information that would be useful in understanding the overdose death data you
have provided.
Data

Additional Information

Population

Free text

Opioid Overdose Deaths

State grantees do not need to
provide this information

2. Opioid Prescribing Patterns and
Prescriber Use of PDMP
In this section, grantees will use PDMP data to report on opioid prescribing patterns
and prescriber use of PDMP in your state, tribal area, or jurisdiction during the 12month reporting period.
Data Source Time Frame (Start Date and End Date)
Indicate the time frame during which data for this measure were collected. Enter the
start date and end date for the time period of the data you are submitting.
Start Date: ________________________________(month/day/year)
End Date: _________________________________(month/day/year)

2.1 Opioid Prescribing Patterns (PDMP Data)
Here, you will enter the data for the PDMP indicators to measure opioid prescribing
patterns.

PDMP Indicators for Opioid Prescribing Patterns
Required Indicators
Population (total number of residents in the state, tribal area, or
jurisdiction)

(State grantees do
not need to provide
population data)

Total number of unique residents prescribed opioid analgesics
Total number of opioid analgesic prescriptions
Total number of high-dose opioid analgesic prescriptions
(>90 MME/day)
Total number of opioid pills dispensed
Average MME/day for all opioid prescriptions dispensed in this period
Percentage of patient prescription days with overlapping opioid and
benzodiazepine prescriptions
Number of multiple provider episodes (unique patients filling
prescriptions from 5 or more prescribers and 5 or more pharmacies in
a 6-month period)
Optional Indicators
Percentage of patient prescription days with overlapping opioid
prescriptions
Total number of patients prescribed by a single provider >90 MME/day
of opioids for 90 or more consecutive days
Total number of prescribers who prescribed >90 MME/day of opioids
for 90 or more consecutive days to any patients

Changes in PDMP Linking Algorithm
For the reporting year, did your PDMP change its algorithm for how it aggregates or
links patients?
Yes (Explain) _______________________________________________________________
No
Data Comments
Please provide any additional information that would be useful in understanding the
PDMP data you have provided related to opioid prescribing practices. Please note
any changes that might have affected data quality for the reporting year and any
changes to the algorithm to aggregate or link patients.

Data
PDMP indicators for opioid prescribing
patterns

Additional Information
Free text

2.2 Prescriber Use of PDMP (PDMP data)
Here, you will enter the data to measure prescriber use of PDMP. If relevant to your
jurisdiction, you may also report on the number of pharmacists registered with the
PDMP.
Prescriber Use of PDMP
Required Indicators for Prescribers
Total number of prescribers who prescribed a schedule II–IV
controlled substance during this annual reporting period, based on
PDMP data (Denominator)
Total number of prescribers registered with the PDMP
Total number of prescribers (or their delegates) who queried the
PDMP
Total number of queries by prescribers (or their delegates) to PDMP
Optional Indicator for Pharmacists/Dispensers
Total number of pharmacists registered with the PDMP
Total number of licensed pharmacists in the state (Denominator)

Data Comments
Please provide any additional information that would be useful in understanding the
PDMP data you have provided related to prescriber use of PDMP. Please note any
changes that might have affected data quality for the reporting year.
Data
Prescriber/dispenser use of PDMP

Additional Information
Free text

3. Consumption: Survey Estimates of
Prescription Drug Misuse and Abuse
Use this section to report any available survey data on nonmedical use of
prescription drugs. These data are intended to reflect changes at the grantee level in
the consumption variable(s) targeted by the SPF-Rx grant.
Note that state grantees do not need to report any state-level National Survey on
Drug Use and Health (NSDUH) data. The PEP-C evaluation team already has access
to state-level NSDUH data to measure nonmedical use of prescription drugs and
prescription pain relievers among individuals age 12 and over. These NSDUH data
will be available to state grantees through the PEP-C MRT. State grantees do have
the option to report other available survey data (e.g., from schools) that may be
relevant to their states’ SPF-Rx goals.
If tribes or nonstate jurisdictions have access to existing survey data (e.g., from
community or school surveys), report that survey data for your consumption
indicator(s) for your target population.
To report survey data, complete the following items, which ask for detailed survey
information.

3.1 Targeted Outcome Measure of Consumption/Prescription
Drug Misuse
Choose the relevant consumption outcome indicator that your survey is measuring.
Prescription Drug Misuse/Abuse
Percentage of target population with any nonmedical use of prescription
drugs in the past 30 days
Percentage of target population with any nonmedical use of prescription
drugs during the past 12 months
Prescription Pain Reliever Misuse/Abuse
Percentage of target population with any nonmedical use of prescription pain
relievers in the past 30 days
Percentage of target population with any nonmedical use of prescription pain
relievers during the past 12 months
Other Targeted Outcome Measure (Need substitute data source request
approval)
Specify substance and measure: ______________________________________
_____________________________________________________________________________
Time Period (Select one):
Past 30-day use
Past 12-month use
Other time period (Specify:____________________________________________)

3.2 Survey Information and Results
a. Name of Survey: __________________________________________________________________
b. Survey Item/Question: Enter the source item verbatim, exactly as it appears
on the survey instrument.
______________________________________________________________________________________
Response Option(s): Enter the entire set of response options verbatim, exactly
as they appear on the survey instrument.
_______________________________________________________________________________________
If applicable, provide the associated codes for each response that was used in
analyses.
__________________________________________________________________________________________
c. Reported Outcome Description: Provide a description of the specific outcome
you will be reporting for this measure; for example, the percentage of 9th grade
students with any nonmedical use of prescription drugs in the past 12 months.
__________________________________________________________________________________________
d. Survey Population Age Range (or grades if school survey): Indicate whether
the survey population was defined by age or grade level, and provide the
applicable age range or grades.
Age Range. Insert below the lower and upper bounds for the age range for
the population represented by the survey. The possible values must fall
between ages 1 and 99. For a community survey of adults, for example, you
would enter age 18 as the lower bound and 99 as the upper bound.
However, if you are reporting results for a subset of adults surveyed—e.g.,
ages 18 to 25—then you would enter age 18 as the lower bound and 25 as
the upper bound.
Minimum_______________

Maximum_______________
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Grades. Select the grade(s) of the population represented by the survey and
for which you are reporting data. For example, if the survey was
administered to grades 9 and 11, and the current data being reported are for
grade 9 students, then select grade 9.
Select applicable grades:
K

College

e. Other Sample Descriptors: Describe any other distinguishing characteristics of
the sample, if applicable. (For example, Latino students only.)
__________________________________________________________________________________________
f. Description of Sampling Design: Indicate what type of sampling was used for
the survey.
Census
Convenience sample
Random sample
Stratified random sample
g. Data Collection Date: Provide the month and year in which the survey was
conducted. If the data collection took multiple months, the month at the middle
of the period should be reported. If it took an even number of months, report the
middle month closer to the end date. If multiple years of data were combined
into a single estimate due to small sample size, insert the month and year of the
most recent survey date and check “multiple year pooled estimate” below. [Note:
Use of multiyear estimates must be preapproved by CSAP.]
Month/Year___________________________________________

Is this a multiple year pooled estimate?
Yes

If Yes: Report the data collection years for the multiyear pooled
estimate you are reporting. For example, 2016; 2017.
_________________________________________________________________

No
h. Value Type: Select the type of number you will report in the Calculated Value
field. If you are reporting a value type other than those listed, select “Other,” and
describe the value type.
Percentage
Mean
Other (Describe)___________________________________________________________
i. Calculated Value: Enter your actual numeric result. For example, you may enter
“.10” to indicate that 10% of the target population reported nonmedical use of
prescription drugs in the past 12 months. _________________

j. Standard Error: Enter the standard error for the calculated value, computed to take
account of the sampling design (e.g., simple random or two-stage cluster design).
_________________

k. Standard Deviation: Enter the standard deviation for the calculated value, computed
to take account of the sampling design (e.g., simple random or two-stage cluster
design). ______________

l. Survey Item Valid N: Provide the total number of respondents with a valid response
(i.e., not missing) to the survey item (the denominator for the data you are reporting).
________________
m. Comments (Maximum 1,500 characters): Provide any comments you feel may be
helpful in understanding the data and information you have provided.
_________________________________________________________________
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Author	Clinton-Sherrod, A. Monique
File Modified	2017-06-16
File Created	2017-06-16