[Federal Register: May 13, 2009 (Volume 74, Number 91)]
[Notices]
[Page 22558-22560]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr13my09-67]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Agency Information Collection Activities: Proposed Collection;
Conunent Request
AGENCY: Agency for Healthcare Research and Quality, HHS.
ACTION: Notice.
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SUMMARY: This notice announces the intention of the Agency for
Healthcare Research and Quality (AHRQ) to request that the Office of
Management and Budget (OMB) approve the proposed information collection
project: ``Health Literacy Item Set Supplemental to CAHPS Hospital
Survey--Pretest of Proposed Questions and Methodology.'' In accordance
with the Paperwork Reduction Act of 1995, Public Law 104-13 (44 U.S.C.
3506(c)(2)(A)), AHRQ invites the public to comment on this proposed
information collection.
DATES: Comments on this notice must be received by July 13, 2009.
ADDRESSES: Written comments should be submitted to: Doris Lefkowitz,
Reports Clearance Officer, AHRQ, by e-mail at
doris.lefkowit@ahrq.hhs.gov.
Copies of the proposed collection plans, data collection
instruments, and specific details on the estimated burden can be
obtained from the AHRQ Reports Clearance Officer.
FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427-1477, or by e-mail at
doris.lefkowitz@ahrq.hhs.gov.
SUPPLEMENTARY INFORMATION:
Proposed Project
``Health Literacy Item Set Supplemental to CAHPS Hospital Survey--
Pretest of Proposed Questions and Methodology''
AHRQ proposes to conduct a pretest of the Consumer Assessment of
Healthcare Providers and Systems (CAHPSR) Hospital Survey health
literacy module. The CAHPS program is a multi-year initiative of the
Agency for Healthcare Research and Quality. AHRQ first launched the
program in October 1995 in response to concerns about the lack of good
information about the quality of health plans from the enrollees'
perspective. Numerous public and private organizations collected
information on enrollee and patient satisfaction, but the surveys
varied from sponsor to sponsor and often changed from year to year. The
CAHPSR program was designed to make it possible to compare survey
results across sponsors and over time, and to generate tools and
resources that sponsors can use to produce understandable and usable
comparative information for consumers.
Over time, the program has expanded beyond its original focus on
health plans to address a range of health care services to meet the
various needs of health care consumers, purchasers, health plans,
providers, and policymakers. Based on a literature review and an
assessment of currently available questionnaires, AHRQ identified the
need to develop a health literacy module for the CAHPSR Hospital
Survey. The intent of the planned module is to examine patients'
perspectives on how well health information is communicated to them by
healthcare professionals in the hospital setting. The objective of the
new module is to provide information to health plans, hospitals,
clinicians, group practices, and other interested parties regarding the
quality of health information delivered to patients. The set of
questions about health literacy will be evaluated as a supplement to
the CAHPSR Hospital Survey.
This study will be conducted for AHRQ by its contactor, RAND
Corporation. It is being conducted pursuant to AHRQ's statutory
authority to conduct research and evaluations on health care and
systems for the delivery of such care, including activities with
respect to the quality, effectiveness, efficiency, appropriateness and
value of health care services. See 42 U.S.C. 299a(a)(1).
This study is a one-time field test to be completed in the calendar
years 2009 and 2010. The field test to be conducted under this request
will be done for the following purposes:
a. Analysis of item wording--Assess candidate wordings for items.
b. Analysis of participation rate--Evaluate the overall response
rate and the proportion of that obtained from mail versus telephone
modes of data collection.
c. Case mix adjustment analysis--Evaluate variables that need to be
considered for case mix adjustment of scores.
d. Psychometric Analysis--Provide information for the revision of
the health literacy item set based on the assessment of the reliability
and validity.
The end result will be collection of the data related to the
assessment of patients' perspective on how well health information is
communicated to them by health care professionals in hospital setting.
The field testing will ensure that future data collections yield high
quality data and minimize respondent burden, increase agency
efficiency, and improve responsiveness to the public. The survey items
will be added to currently available CAHPS R surveys and will enhance
the ability of hospitals to assess the quality of their services.
Method of Collection
The potential respondent universe is persons who had at least one
overnight stay at a hospital within the previous five months. Excluded
from the study will be those who were less than 18 years old at the
time of their admission, had a psychiatric diagnosis, were
[[Page 22559]]
discharged to a hospice facility or died during the hospitalization.
Testing sites will be selected purposively based on several
considerations, including ability to execute the activities necessary
to participate in the pilot, number of beds, number of discharges for
medical, surgical, and obstetric patients, average length of stay,
location (urban versus rural), profit status, and academic medical
center status.
The draw will be a sample large enough to yield approximately 600
completes. It is assumed that approximately 1200 patients will be
sampled across all field sites with a response rate of 50%. This
pretest will use a mixed mail-telephone mode of data collection which
will include the following steps:
Mailing an advanced notification letter
Mailing of the questionnaire and cover letter
Postcard reminder
A second mailing of the questionnaire to non-respondents.
Up to 10 telephone calls to every mail non-respondent
approximately two weeks after the final mailing.
Every effort will be made to maximize the response rate, while
retaining the voluntary nature of the effort. An advanced notice will
be mailed prior to mailing the survey and will include a letter
explaining what the survey is about, who is doing it and why, and
providing contact information for questions. The second mailing and
telephone follow-up are expected to result in significant increases in
response. Every effort to maximize the response rate among Spanish-
speaking respondents will be made. A Spanish version of the advance
notice, the questionnaire, cover letters, and the reminder card, as
well as a Spanish version of the telephone transcript have been
developed. The cover letters in English include a note in Spanish
instructing respondents to call a toll free number if they would like
to receive a copy of the survey in Spanish. In addition, participating
field sites will ask for information on language preference and/or
race/ethnicity of sample patients so that the mailing of the survey can
be tailored for Spanish-speakers.
Finally, phone follow-up to respondents who do not complete the
survey by mail will be conducted by bilingual interviewers so that
those who want to complete the survey by telephone in either English or
Spanish can be accommodated.
Surveys generally do not yield complete responses from every
individual sampled from the population. In this analysis, patterns of
both unit and item nonresponse will be examined and modeled, and the
potential impact of nonresponse bias assessed. A common set of
administrative variables (e.g., age, gender, race/ethnicity) will be
used to predict unit nonresponse. These variables and others collected
on the survey itself will be used as predictors of item nonresponse.
Case mix adjustment and nonresponse weights will be used to more
accurately reflect consumer experiences with health care in the field
test hospitals. Multivariate logistic regression models will be used to
analyze the factors associated with unit nonresponse and item
nonresponse.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden for the
respondents' time to participate in this data collection. The CAHPS
Hospital Survey Health Literacy Module will be completed by about 600
persons in total, or an annual average of 400 persons per year for the
18 months of the pretest. The estimated response time of 20 minutes is
based on the written length of the survey and AHRQ's experience with
previous CAHPS[supreg] surveys of comparable length that were fielded
with similar samples. The total annualized burden hours are estimated
to be 133 hours.
Exhibit 2 shows the respondents' cost burden associated with their
time to participate in this data collection. The total annualized cost
burden is estimated to be $2,601.
Exhibit 1--Estimated Annualized Burden Hours
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Number of
Form name Number of responses per Hours per Total burden
respondents respondent response hours
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Mail survey with reminder card, mail and phone 400 1 20/60 133
follow-up mail and phone follow-up.............
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Total....................................... 400 1 na 133
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Exhibit 2--Estimated Annualized Cost Burden
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Number of Total burden Average hourly Total cost
Form name respondents hours wage rate* burden
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Mail survey with reminder card, mail and phone.. 400 133 $19.56 $2,601
follow-up.......................................
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Total....................................... 400 133 na 2,601
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* Based upon the average wages, ``National Compensation Survey: Occupational Wages in the United States, May
2007,'' U.S. Department of Labor, Bureau of Labor Statistics.
Estimated Annual Costs to the Federal Government
The total cost for the contracted service is approximately $245,000
and the cost for AHRQ staff to oversee the project is $50,000,
including benefits. The project was initiated in October of 2008 and it
is forecasted that it will be completed in 18 months. It is estimated
that the total cost of the project is approximately $295,000. The
annualized cost of the project is approximately $196,669.
[[Page 22560]]
Exhibit 3--Estimated Cost
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Annualized
Cost component Total cost cost
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Review of literature.................... $20,000 $13,334
Cognitive interviews.................... 60,000 40,000
Field test.............................. 90,000 60,000
Data analyses........................... 40,000 26,667
Finalize survey......................... 35,000 23,334
AHRQ project management................. 50,000 33,334
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Total............................... 295,000 196,669
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Request for Comments
In accordance with the above-cited Paperwork Reduction Act
legislation, comments on AHRQ's information collection are requested
with regard to any of the following: (a) Whether the proposed
collection of information is necessary for the proper performance of
AHRQ health care research and health care information dissemination
functions, including whether the information will have practical
utility; (b) the accuracy of AHRQ's estimate of burden (including hours
and costs) of the proposed collection(s) of information; (c) ways to
enhance the quality, utility, and clarity of the information to be
collected; and (d) ways to minimize the burden of the collection of
information upon the respondents, including the use of automated
collection techniques or other forms of information technology.
Comments submitted in response to this notice will be summarized
and included in the Agency's subsequent request for OMB approval of the
proposed information collection. All comments will become a matter of
public record.
Dated: May 4, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9-11012 Filed 5-12-09; 8:45 am]
BILLING CODE 4160-90-P