[Federal Register: August 25, 2003 (Volume 68, Number 164)]
[Notices]
[Page 51017-51018]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr25au03-40]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Request for Measures of Patients' Hemodialysis Care Experiences
AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS.
ACTION: Notice of request.
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SUMMARY: The Agency of Healthcare Research and Quality (AHRQ) is
soliciting the voluntary submission of instruments measuring patient
perspectives of their experience with hemodialysis facilities from
researchers, vendors, stakeholders and other interested parties. AHRQ
and the Centers for Medicare & Medicaid Services (CMS) have set as a
priority the development of a standardized survey that may be used to
make widely available, comparable measurements of hemodialysis patient
experiences. Therefore, AHRQ is assessing the feasibility of creating
such a standardized instrument and the nature and scope of the work to
be done. As part of the feasibility study, AHRQ is reviewing existing
instruments that capture patients' treatment experiences and is
therefore requesting voluntary submission of such instruments or
measures along with documentation for administration of the instruments
or measures and, if possible, critical evaluations of particular
measures or related survey administration techniques.
DATES: Parties interested in contributing to this endeavor are asked to
submit the requested material on or before October 24, 2003 to Beth
Kosiak, Ph.D. (see address below). AHRQ will not reply to individual
responses, but will consider all submissions and suggestions.
ADDRESSES: Submissions should include a brief cover letter and include
copy of the instrument or particular measure(s) for consideration. They
may be in the form of a letter or e-mail, preferably with an electronic
file in a standard word processing format such as Microsoft Word or
Word Perfect on a 3\1/2\ inch diskette enclosed or as an e-mail with an
e-mail attachment. Electronic submissions are strongly encouraged.
Responses to this request should be submitted to: Beth Kosiak, PhD,
Agency for Healthcare Research and Quality, 540 Gaither Road,
Rockville, MD 20850, Phone: (301) 427-1322, Fax: (301) 427-1341, e-
mail: bkosiak@ahrq.gov. In order to ease the handling of submissions, please send a copy of
the instrument or measure(s), and a cover letter addressing the extent
to which the information submitted meats the ``Submission Criteria''
below. A copy or citation of relevant peer-reviewed journal articles is
also desirable, but not required. For citations, please include the
title of the article, author(s), publication year, journal name,
volume, issue, and page numbers where article appears. All submissions
must include a statement of willingness to grant to AHRQ the right to
use and authorize others to use submitted measures and their
documentation as part of a CAHPS[reg]-trademarked instrument. Any CAHPS
instrument developed for patient perspectives of experiences of
hemodialysis care will be made publicly available for use free of
charge. However, a CAHPS instrument bearing the CAHPS trademark may
only be administered following CAHPS documentation and instructions. To
facilitate our obtaining any other required clarifications, please
submit the following information with respect to a knowledgeable
contact person: (a) Name, (b) title, (c) organization, (d)
[[Page 51018]]
mailing address, (e) telephone number, and (f) e-mail address. For
clarity, please do not use acronyms without explanation..
FOR FURTHER INFORMATION CONTACT: Beth Kosiak, PhD, from the Center for
Quality Improvement and Patient Safety, Agency for Healthcare Research
and Quality (see contact information above).
Submission Criteria
Measures submitted should ideally reflect these elements to be
considered: (a) They must capture the patients' perspective on their
experience of care in hemodialysis settings; (b) have a high degree of
reliability and validity; and (c) have been used widely, not just in
one or two research studies or local dialysis settings. It is
recommended that submitters provide documentation that the
instrument(s) or measure(s) they submit meets these criteria. The
following information, if available, should be included in the
submission of materials: the name of the instrument, domains assessed,
language(s) in which the instrument is available, evidence of cross
group/cultural comparability if any, examples of uses of the instrument
for quality assessment or improvement, scale, psychometric statistics,
such as individual level reliability (e.g., internal consistency, test-
retest), group level reliability, item response theory (IRT)
statistics, validity (content, construction, criterion), as well as
cognitive interviews and field test results, and details about focus
groups.
Submitters are also encouraged to submit recommendations regarding,
and any evaluations of, administration protocols, including recommended
patient contact procedures, recommended sample sizes, mode of
administration, any information available about mode effects, and mode
specific response rates. Evidence of the criteria may be demonstrated
by providing peer-reviewed journal article(s) or citations thereof.
As noted above submitters must indicate a willingness to grant to
AHRQ the right to use and authorize others to use the submitted
instrument or particular measures or formats therein. The license or
assignment of rights will make it possible to apply the CAHPS trademark
to a new instrument combining the best features of all the submissions
as well as any ideas that may develop from reviewing them. AHRQ will
not simply adopt one instrument and apply the CAHPS trademark to it.
Rather, AHRQ, in collaboration with its CAHPS grantees, will evaluate
all submitted instruments and measures, select several, either in whole
or in part, for testing, or more likely devise one or more for testing
and, as required, make additional modifications for the final product.
AHRQ will assume responsibility for the final measure set as well as
any further modifications to the developed instruments. Sources used in
developing the final product will be acknowledged by AHRQ in the
appropriate forum. In addition, all submissions will be publicly
reported in aggregate.
The finalized instrument will bear the CAHPS trademark. As
indicated above, it will be made freely available for use by all
interested parties. There will be free access to the instrument's
supportive/administrative information as well, and as a matter of
quality control, there will be warnings that the CAHPS identification
may not be used if any changes are made of the instrument or final
measure set, without review and permission of the agency. AHRQ will
assume responsibility for the final measure set as well as any further
modifications to the developed instrument.
SUPPLEMENTARY INFORMATION:
Background
The Agency for Healthcare Research and Quality has been a leading
proponent and supporter of the development of instruments for measuring
patient experiences within the healthcare system of the United States.
Through prior CAHPS patient survey development efforts such as the
Consumer Assessment of Health Plan CAHPS[reg], AHRQ has been
able to provide valuable information to consumers and purchasers alike.
While the Health Plan CAHPS[reg] tool is highly regarded
within the industry and provides valuable information to consumers and
purchasers, it does not address hemodialysis patient experiences of
care.
Leaders in the healthcare sector have called for a response to this
pressing need. In ``Crossing the Quality Chasm'', the National
Institute of Medicine (IOM) established patient-centered care as one of
the industry's six aims for quality improvement. The dimensions of
patient-centered care include: Respect for patients' values,
preferences, and expressed needs; coordination and integration of care;
information, communication, and education; physical comfort; emotional
support, i.e., relieving fear and anxiety; involvement of family and
friends (2001). From past experience, AHRQ suggests the addition of two
more aims for quality improvement: Continuity and transition; and
access to care. To measure these dimensions will require a standardized
instrument that produces reliable and valid results.
In an effort to address the concerns of the industry, the Director
AHRQ and the Administrator of CMS have established a priority to
develop a standardized measure of hemodialysis patients' experiences.
The goal of developing the standardized survey and reporting quality
data on hemodialysis facilities could be reached within the next few
years.
The steps to advance this initiative include:
[sbull] Stakeholder and Technical Expert Panel Meetings: A series
of meetings will be held to identify the issues, concerns and interests
of the healthcare community. Summaries of these meetings will be posted
on the AHRQ Website: http://www.ahrq.gov/.
[sbull] Feasibility Study: The process to access the feasibility of
developing a national standardized survey instrument to measure patient
experiences with hemodialysis care. As part of the study, the potential
uses of the instrument such as quality improvement, public reporting,
or both will be assessed.
[sbull] Research Plan: The process by which measures will be
defined and applicable instruments identified. Instruments submitted
will be evaluated to determine if they meet the measurement needs and
to identify whether additional measure development is required. The
standardized instrument will reside in the public domain.
[sbull] Implementation Plan: A process to implement the
standardized survey will be established to include information related
to data collection, analysis, and reporting.
Dated: August 14, 2003.
Carolyn M. Clancy,
Director.
[FR Doc. 03-21555 Filed 8-22-03; 8:45 am]
BILLING CODE 4160-90-M