Form Community-Level Ou Community-Level Ou Community-Level Outcomes

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

Contents
Section

Page

Information and Directions

1

1.

2

2.

3.

Opioid Overdose Morbidity and Mortality
1.1

Hospital Data for Opioid Overdoses

2

1.2

Other Opioid Overdose Events (for Approved Substitute Data Source)

4

1.3

Opioid Overdose Deaths

5

Opioid Prescribing Patterns and Prescriber Use of PDMP

7

2.1

Opioid Prescribing Patterns (PDMP Data)

8

2.2

Prescriber Use of PDMP (PDMP data)

9

Consumption: Survey Estimates of Prescription Drug Misuse and Abuse

10

3.1

Targeted Outcome Measure of Consumption/Prescription Drug Misuse

10

3.2

Survey Information and Results

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Information and Directions
In this Community-Level Outcomes Module, grantees report outcome data each year
for their subrecipient communities. Grantee-level outcome data are reported in the
Grantee-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).
“Subrecipient community” refers to the community entities that receive funds
from the grantee to carry out SPF-Rx activities at the community level.
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).

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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 opioid overdose data for subrecipient communities,
including 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).
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)

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

Numerical

Numerical

Numerical

Numerical

Numerical

Data Source(s): List all data sources for your data.
___________________________________________________________________________________________
Data Comments
Please provide any additional information about the data source 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

3

1.2 Other Opioid Overdose Events (for Approved Substitute
Data Source)
This is where you report any alternative opioid overdose data for your subrecipient
communities if you do not have access to hospital data. First, you would need to
submit a substitute data 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:_____________________________)

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Other Opioid Overdose Events (for Approved Substitute Data Source)

Total

Population
(Denominator)

Other Opioid
Overdose Events
(optional)

Total Number of
Events
(Denominator)

Numerical

Numerical

Numerical

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 report data on opioid overdose deaths for any subrecipients
that are not counties. Grantees do not need to report any opioid overdose death data
for counties because these data will be pulled from the Centers for Disease Control
and Prevention’s WONDER database. Report at the closest available substate
geographic unit for each non-county subrecipient community (e.g., community or
district), if available.
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)

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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:_____________________________)

Opioid Overdose Deaths
In the table below, provide the total population (total number of residents in the
jurisdiction), the total number of opioid deaths, and the total number of deaths.
Opioid Overdose Deaths
Population
(Denominator)

Opioid Overdose
Deaths

Total Deaths

Numerical

Numerical

Numerical

Total

Data Source(s): List all data sources for your data.
___________________________________________________________________________________________
Data Comments
Please any additional 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

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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 their subrecipient communities during the 12-month
reporting period. Provide data for the closest available substate geographic unit
(e.g., community, county, or district).
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)

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2.1 Opioid Prescribing Patterns (PDMP Data)
Here, you will enter the data for the PDMP indicators to measure opioid prescribing
patterns in your subrecipient communities.
PDMP Indicators for Opioid Prescribing Patterns in Subrecipient Community
Required Indicators
Population (total number of residents in the geographic area for which
you are reporting subrecipient community PDMP 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
Optional Indicators
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)
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

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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 in your
subrecipient communities. If relevant to your subrecipient communities, you also
have the option to report on the number of pharmacists registered with the PDMP.
Provide data for the closest available substate geographic unit (e.g., community,
county, or district). Use the same unit you reported for item 2.1.
Prescriber Use of PDMP in Subrecipient Community
Required Indicators for Prescribers
Total number of prescribers in the subrecipient community who
prescribed a schedule II–IV controlled substance during this annual
reporting period, based on PDMP data (Denominator)
Total number of prescribers in the subrecipient community who are
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)

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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 in your subrecipient communities. These data are intended to
reflect changes at the community level in one or more consumption variables
targeted by the SPF-Rx grant. Provide data for the closest available substate
geographic unit (e.g., community, county, or district/region).
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 the 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

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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.
__________________________________________________________________________________________

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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_______________

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

3

6

9

12

1

4

7

10

College

2

5

8

11

e. Other Sample Descriptors: Describe any other distinguishing characteristics of
the sample, if applicable. (For example, Latino students only.)
__________________________________________________________________________________________
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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)___________________________________________________________

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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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