Form 0920-25-0128 AttA_OD2AS_PM Technical Guidance_ 2025 May

Form approved:

OMB Control Number: 0920-1282

Expiration date: 06/30/2026

OD2A-S Performance Measures Technical Guidance

Division of Overdose Prevention

State Program and Implementation Branch

May 2025

CDC estimates the average public reporting burden for this collection of information as 35 hours annually per response from each recipient, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1282)

Acknowledgments

We want to acknowledge everyone who played a crucial role in the development of performance measures for Overdose Data to Action in States (OD2A-S). This would not have been possible without the dedication, expertise, and collaboration of a diverse group of public health partners. Special thanks to the subject matter experts at the Centers for Disease Control and Prevention (CDC), whose invaluable insights and domain knowledge shaped the selection and prioritization of indicators. Thank you also for the active engagement of our recipients during the initial performance measures webinar, whose feedback provided essential perspectives and ensured the relevance of our measures. Finally, thank you to the evaluators from the Program Evaluation Team, who each played a critical role in the development of this guide. This collective effort underscores the spirit of collaboration and commitment that defines our work in OD2A-S.

Contents

Introduction 4

Purpose and Objectives 4

Data Quality 4

OD2A-S Performance Measures 6

Quick View 6

Key Reporting Fields 7

HE_Impact 10

HE_Activities 12

HR_Encounters 14

HR_Naloxone 16

LTC_Navigators 18

LTC_Referrals 20

HS_Training 23

HS_SUD_Protocols 25

Reporting 27

Reporting Process 27

Excel Reporting Tool 28

Reporting Timeline 28

Acronyms 30

Glossary 31

Introduction

This technical guidance is specifically developed to support recipients of Overdose Data to Action in States (OD2A-S) in their reporting of performance measures, also referred to as indicators. Performance measures will be reported by recipients during the period of funding to track progress on key interventions and outcomes as outlined in the Notice of Funding Opportunity (NOFO).

This Technical Guidance will support recipients to collect and report on the outlined performance measures. This document includes:

• Introduction

• Snapshot of performance measures

• Detailed descriptions of each performance measure

• Reporting timeline and guidance

• Appendices (acronyms and glossary)

Purpose and Objectives

The primary goal of performance measures in OD2A-S is to provide a common set of indicators that will be used by recipients and their partners to monitor progress and identify areas for improvement. Performance measures data can be used to help:

1. Recipients show progress and communicate progress to their health department leadership.

2. CDC and recipients inform future CDC programmatic investments.

3. CDC and recipients understand the contributions of OD2A-S across overdose prevention strategies and use data for programmatic improvement.

4. CDC communicates with Health and Human Services (HHS) and other federal policymakers about the progress made under OD2A-S.

At CDC, these performance measures are not meant to compare jurisdictions to each other, but rather to monitor progress for a recipient over time and to examine OD2A-S as a program, overall. By establishing and regularly monitoring performance measures, recipients can identify areas of strength, pinpoint challenges, and align their efforts with intended objectives, ultimately fostering accountability and continuous enhancement within their programs.

Data Quality

We strive for high-quality data reported across performance measures. High-quality data ensures that the information collected is accurate, consistent, and reflective of the true impact of program activities. Addressing data quality requires a proactive approach to include staff training, standardized data collection protocols, regular data quality assurance checks, and continuous monitoring and improvement processes. Investing in data quality enhances the credibility of performance measures, supporting evidence-based decision-making and ensuring the program's overall success. Consider the following:

• Accuracy – The information collected should clearly and adequately measure the indicator within a plausible range.

• Consistency – Written documentation of data collection and analysis methods can ensure the same procedures are followed each time.

• Timeliness – The information collected should be available to inform program management decisions and it should represent the most current data available. Reporting the data soon after it is collected is a good practice and can help to reflect the true impact of program activities.

• Integrity – Safeguards should be established to minimize the risk of bias or errors in data transcription. This may be achieved by having more than one person conduct the data transcription. In addition, there should be independence in key data collection, management, and assessment procedures and mechanisms to prevent unauthorized changes to the data.

We are asking OD2A-S recipients to keep us informed if you identify any data quality concerns and challenges in data collection or reporting processes that could affect data quality. Each of the performance measures includes data quality and contextual questions in which any data quality concerns should be shared with CDC. Ultimately, we want to ensure that performance measure data we review and share account for any needed caveats regarding data quality.

OD2A-S Performance Measures

There are 8 performance measures. There are 7 quantitative measures and 1 qualitative measure. The labels and brief descriptions are listed here for a quick reference. All quantitative data should be answered in the Excel reporting tool. All qualitative questions including HE_Impact, contextual questions, and data quality questions should, be reported directly in Partners Portal.

Quick View

Icon	Label Name		Performance Measure
		HE_Impact	Impactful practices for improving access to care and treatment for disproportionately affected populations
		HE_Activities	Number of health impact focused overdose prevention interventions focused on disproportionately affected populations implemented with OD2A funding
		HR_Encounters	Number of harm reduction service encounters at OD2A funded or supported organizations
		HR_Naloxone	Number of naloxone doses distributed by OD2A funded or supported organizations
		LTC_Navigators	Number of navigators who link PWUD to care and harm reduction services via warm handoffs
		LTC_Referrals	Number of referrals to care and harm reduction services
		HS_Training	Number of clinicians who received training on implementing the “2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain”
		HS_SUD_Protocols	Number of health settings implementing or improving protocols and/or policies for evidence-based substance use disorder (SUD) treatment or referrals

This guide uses a standard format to describe each performance measure. Each indicator reference sheet is organized by an overview of the measure and its key reporting fields. Each indicator reference sheet includes a section on reporting specifications to explain exactly what needs to be reported for each performance measure. Each quantitative measure includes required and optional disaggregates, contextual questions, and data quality questions. Contextual questions are required and help recipients explain any nuances in the data and provide a fuller picture of the quantitative measures. Data quality questions are included for you to provide information about the data reported to help explain representativeness, completeness, and other data quality considerations.

Key Reporting Fields

Label	Used to give a shorthand to each measure
Name	Descriptive name of performance measure
Unit of Measure	Quantitative value (e.g., count or percentage)
Numerator	Suggested numerator
Denominator	Suggested denominator (if applicable).
Disaggregates	The separation of indicators into smaller units to identify underlying trends and patterns. Allows for understanding of how subgroups are impacted differently. All disaggregates are required unless otherwise noted as optional.
Reporting Specifications	Descriptions that operationalize how to report each measure to CDC
Contextual Questions	Questions to improve CDC’s understanding of numeric data. As a complement to the reported performance measures data, recipients are asked to provide qualitative contextual explanatory information.
Data Quality	Specific questions for which recipients should describe data quality and representativeness of the data, for example, issues or concerns with respect to data quality and completeness.

Indicator Reference Sheets for Each Performance Measure

HE_Impact

Impactful practices for improving access to care and treatment fordisproportionately affected populations

Key Reporting Fields
Primary Measure	This is a qualitative measure. It is a narrative description of the impactful practices you observe in your jurisdiction that improve access to care and treatment for PWUD. There is no quantitative reporting required for this performance measure. This may be reported in Partners Portal.
Disaggregates	N/A
Reporting Specifications	The following format is recommended for reporting this qualitative indicator:   Brief description of the implemented and/or tailored (adapted to specific cultural, linguistic, environmental, or social needs of populations) evidence-based intervention or innovative practice (including setting and whether navigators were included if applicable) and how these compare to previous efforts.  How access to care or treatment has been improved, and what new/existing community assets were leveraged.   Which specific populations disproportionately affected by overdose and underserved with care and treatment programs are impacted by efforts (if tracked).   This is optional. Any other outcomes that were improved (provides recipients the option to expand beyond access to care and include any other outcomes, for example, like retention in care, decreased opioid use).    The length of the narrative should be succinct, but each impactful practice* should have a descriptive paragraph if more than one is outlined.     *Note: If your jurisdiction or partners have not implemented any impactful practices at the time of reporting, please note in the relevant data submission field “no practices have been implemented to improve access to care and treatment to date.”

Contextual Questions	What barriers prevent achieving access to care and treatment for SUD?  What facilitators support achieving access to care and treatment for SUD?
Data Quality	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).

HE_Activities

Number of health impact overdose prevention interventions focused on disproportionately affected populations implemented with OD2A funding

Key Reporting Fields
Primary Unit of Measure	Total count of health impact activities
Disaggregates	Settings Health/Clinical (e.g., emergency department, hospitals, clinics, outpatient, inpatient, primary care, pharmacies) Harm reduction (e.g., syringe services programs) Public safety (e.g., criminal justice, EMS) Other
Reporting Specifications	Total_HE_Activities This is a formula field that will generate a total count of health impact focused overdose prevention interventions focused on disproportionately affected populations 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 impact overdose prevention activities that occurred in a health/clinical setting. HE_HR_Settings Enter a whole number that reflects the health impact focused overdose prevention activities that occurred in a harm reduction setting. HE_Public_Safety_Settings Enter a whole number that reflects the health impact 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 impact focused overdose prevention activities that occurred in any setting outside of clinical, harm reduction, and public safety.
Contextual Question	1. Please describe the activities in this performance measure, for whom they were intended, and how the activities were implemented and/or tailored (e.g., linguistically, culturally) for disproportionately affected populations?
Data Quality	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).

HR_Encounters

Number of harm reduction service encounters at organizations funded or supported by OD2A

Key Reporting Fields
Primary Unit of Measure	Total count of service encounters
Disaggregates	Selected harm reduction services: Number of service encounters where in-person drug checking occurred, and result was provided back to participant (e.g., use of FTIR/mass spectrometer) Locations where harm reduction services were provided: Zip code(s) where service is delivered. (Note: this is NOT the zip code of the participant residence)
Reporting Specifications	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 organization during the designated reporting period. Encounters_with_Drug_Checking Enter a whole number for service encounters where drug checking occurred.

Reporting Specifications (Continued)	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 where the outreach encounter happened. 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.
Contextual Questions	What are the barriers for people accessing harm reduction services in your jurisdiction? What are the facilitators for people accessing harm reduction services in your jurisdiction? What types of services are included? Please estimate the proportion of harm reduction service encounters that occurred: ___ % at brick and mortar locations ___ % via mobile-based outreach services ___ % via mail-based delivery ___ % other (please specify)
Data Quality	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). How many OD2A-funded organizations are included in the data submitted?

HR_Naloxone

Number of naloxone doses distributed by OD2A funded or supported organizations

Key Reporting Fields
Primary Unit of Measure	Total count of pre-measured naloxone doses distributed
Disaggregates	Type of funded organization (e.g., Syringe Service Programs, community-based organizations, senior care organizations, faith-based organizations, Emergency Department/Urgent Care, Other healthcare organizations, Police departments, Jails/Prisons, Colleges/Universities, Secondary education, Health Department) Number of all pre-measured naloxone doses distributed by organization. Zip code(s) where the organization distributed their doses (Note: if distributed at a brick-and-mortar location like an SSP, use the zip code of the SSP. This is NOT the zip code of the participant residence) Number of all pre-measured naloxone doses distributed by zip code.
Reporting Specifications	Total_Naloxone_Distributed Enter a whole number for doses of naloxone distributed by an OD2A 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.

Reporting Specifications (Continued)	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.
Contextual Questions	What are barriers to accessing or receiving naloxone? What are facilitators to accessing or receiving naloxone? How did you use OD2A Funds to distribute naloxone (e.g. staffing to distribute, vending machines)? This contextual question is optional. Describe mechanisms used to distribute naloxone (e.g., mail in, handoffs).
Data Quality	If you selected “other” Type of organizations in the reporting tool, please describe. 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).

LTC_Navigators

Number of navigators who link PWUD to care and harm reduction services via warm handoffs

Key Reporting Fields
Primary Unit of Measure	Total count of unique navigators who link PWUD
Disaggregates	Entry points where navigators are primarily located: Health/Clinical (e.g., emergency department, hospitals, clinics/practices, outpatient, inpatient, treatment centers, primary care, pharmacies) Harm reduction (e.g., syringe services programs) Public safety (e.g., criminal justice, EMS) Other This disaggregate is optional. Number of hours navigators spent on linkage efforts
Reporting Specifications	Total_Navigators This is a formula field that will generate a total count of unique navigators who link PWUD to care and/or harm reduction services via warm handoffs once the disaggregates below are entered into the appropriate fields. 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.

Reporting Specifications (Continued)	Nav_Other Enter a whole number for the navigators 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.
Contextual Questions	Describe what types of navigators are included in the data reported (e.g., certified peer recovery specialists, peer support specialists, case managers, patient navigators, community health workers, persons with lived experience, etc.).  Describe methods to support navigators, including average hourly pay, benefits, and additional supports (e.g., trauma, wellness, emotional/psychological support, infrastructure such as a phone) to help retain them.
Data Quality	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).

LTC_Referrals

Number of referrals to care and harm reduction services

Key Reporting Fields
Primary Unit of Measure	Total count of unique referrals Note: If you refer one individual to both MOUD and harm reduction services, you would account for 2 different referrals as you will report by each service. If you refer the same individual multiple times, they would be counted multiple times. This indicator is not counting unique individuals, but rather referral encounters.
Disaggregates	Types of care/service referrals: Number of referrals to medications for opioid use disorder (MOUD) Number of referrals to behavioral health treatment only (without MOUD) Number of referrals to harm reduction services Demographics of people who are referred: Race and Ethnicity (American Indian or Alaska Native, Asian, Black, or African American, Hispanic, or Latino, Middle Eastern or North African, Native Hawaiian or Other Pacific Islander, White, Multiracial and/or Multiethnic, Unknown)

Reporting Specifications	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.
Contextual Questions	Types of Referrals This contextual question is optional. If you have other OD2A funded or supported referrals beyond referrals to MOUD, behavioral treatment only (without MOUD), and harm reduction services. Please describe the “other” types of referrals. Reporting Partners Approximately, what % of healthcare facilities (e.g., hospitals, emergency departments, other clinical settings) reported data to your jurisdiction for this performance measure? (If % not available, report total number of healthcare facilities that reported). Approximately, what % of EMS agencies reported data to your jurisdiction for this performance measure? (If % not available, report total number of EMS agencies that reported).
	Approximately, what % of carceral settings (e.g., prisons and jails), reported data to your jurisdiction for this performance measure? (If % not available, report total number of carceral settings that reported). Approximately, what % of harm reduction settings (e.g., SSPs) reported data to your jurisdiction for this performance measure? (If % not available, report total number of carceral settings that reported).
Meta Data / Data Quality	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).

HS_Training

Key Reporting Fields
Primary Unit of Measure	Total count of OD2A-S clinicians trained
Numerator	Count of clinicians trained
Disaggregates	This disaggregate is optional. Specialty (e.g., Primary care, Emergency medicine, Hospitalists, Surgeons, OB/GYNs, Neurologists, Dentists, Physical medicine and rehabilitation, Occupational medicine, Pharmacists) This disaggregate is optional. Number of unique clinicians trained This disaggregate is optional. Number of eligible clinicians This disaggregate is optional. Percentage of eligible clinicians trained
Reporting Specifications	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 Optional disaggregate: 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 Optional disaggregate: If a specialty is 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.

Number of clinicians who received training on implementing the “2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain”

Reporting Specifications (Continued)	Num_Eligible Optional disaggregate: If a specialty 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 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.
Contextual Questions	Describe the trainings including the title, number offered, length, who conducted them, and where the training occurred. This contextual question is optional. What populations are served by the clinicians who were trained? What are barriers to effectively training clinicians on the “2022 CDC Clinical Practice Guideline”? What are facilitators to effectively training clinicians on the “2022 CDC Clinical Practice Guideline”?
Data Quality	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).

HS_SUD_Protocols

Number of health/clinical settings implementing or improving protocols and/or policies for evidence-based SUD treatment or referrals

Key Reporting Fields
Primary Unit of Measure	Total count of health/clinical settings
Disaggregates	Number of health/clinical settings where protocols or policies have been implemented/improved for evidence-based SUD treatment Number of health/clinical settings where protocols or policies have been implemented/improved for evidence-based SUD referrals
Reporting Specifications	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.
Contextual Questions	Describe how access to MOUD for healthcare settings has changed since implementing policies or protocols.  Describe the partnerships for SUD referral with the health settings included in this indicator. What steps were taken to develop and build the partnerships for SUD referrals?
Data Quality	What types of health settings are included in the reported data?  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).

Reporting

OD2A-S recipients are expected to report on all performance measures on an annual basis. We have selected a short list of measures we believe are feasible for most recipients to report on. This does not limit what individual health departments want to capture for their use, and individual recipients can examine their capacities to collect, analyze, and disseminate additional performance measure data.

Data collection may be ongoing in each individual health department with partners reporting to health departments monthly or quarterly at minimum to allow for discussion and potential course corrections early on. As part of the performance measures submission, DOP staff at CDC commits to review the data, engage with recipients in discussion of the data, and learn from health departments’ experiences and expertise gathered through prior and ongoing efforts to collect data and justify overdose prevention programs. Once data quality is at a sufficient place, CDC will share data reports back to individual recipients with their data for use within their own health department. CDC will use the data along with work plans and APRs to craft case studies and stories to share with CDC leadership, Health and Human Services, and other federal policymakers, as well as with recipients. CDC will find opportunities for mutual learning, growth, and sharing best practices so that we can all learn from each other.

Reporting Process

The current plan is to report performance measure data in the Partner’s Portal. The 1 qualitative performance measure, contextual questions, and data quality questions will be submitted directly into the Partner’s Portal platform. Data for the 7 quantitative measures along with their disaggregates will be submitted using the Excel reporting tool we developed—the Excel tool will be submitted as an attachment within Partner’s Portal. The Excel tool has a tab titled, “Start Here.” Please read the information on that tab before entering data.

Please note that CDC is requesting that jurisdictions enter all counts—please do not suppress small numbers. All numbers will be available to the CDC OD2A-S Program Evaluation Team, and small counts will not be shared with anyone outside the support team. The CDC OD2A-S Program Evaluation Team will aggregate small counts before any data are shared, and we will consult with recipients on plans to share data. 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.

Excel Reporting Tool

Performance measures will be reported using the Partner’s Portal (see reporting process above). To aid in data collection with your partners and provide a clearer roadmap for data collection including required and optional disaggregates, we have developed an Excel-based tool, OD2A-S Performance Measures Reporting Tool.

Example of OD2A-S Performance Measures Reporting Tool