[Federal Register: March 5, 2009 (Volume 74, Number 42)]
[Notices]
[Page 9613-9615]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr05mr09-47]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Agency Information Collection Activities: Proposed Collection;
Comment 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: ``Coordinating Care across Primary Care and Specialty Care
Practices.'' In accordance with the Paperwork Reduction Act of 1995, 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 May 4, 2009.
ADDRESSES: Written comments should be submitted to: Doris Lefkowitz,
Reports Clearance Officer, AHRQ, by e-mail at
doris.lefkowitz@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
``Coordinating Care Across Primary Care and Specialty Care Practices''
AHRQ proposes an evaluation of the redesign of the transitions of
care between primary care and specialty care services. The purpose of
the redesign is to remedy inefficiencies in the current referral
processes that threaten care quality and safety, and system efficiency.
This redesign is being implemented at the Boston Medical
[[Page 9614]]
Center (BMC), and two affiliated health centers. The evaluation will be
conducted for AHRQ by its contractor, the Boston University School of
Public Health (BUSPH).
Care coordination has been identified by the Institute of Medicine
(IOM) as a key strategy with potential to improve the effectiveness,
safety and efficiency of the health care system. At the same time, care
coordination, particularly in transitions among sites of care, is often
lacking. Research shows that problems in coordination of care and
common failures in patients' transitioning between and among systems
typically create serious quality concerns in many settings. Individuals
moving across systems of care and between care providers are vulnerable
to fragmented and disjointed care (Coleman et al., 2004). Uncoordinated
and fragmented transitions can lead to a wide range of costly problems
and threats to patient safety including greater use of hospital and
emergency services (Coleman et al., 2004), ordering and completion of
redundant tests (Coleman & Berenson, 2004), prescription and medication
errors and use of poly-pharmacy by multiple providers (Coleman &
Berenson, 2004). The end result is often confusion about conflicting
care plans and lack of follow-up care. The aim of this evaluation is to
address this confusion and fragmentation by expanding knowledge of how
to improve the experience and outcomes for patients in transitions of
care between primary care and specialty practices. The initial focus is
on referrals between primary care and two specialties: gastroenterology
(GI) and obstetrics (OB). The redesigned referral system will be tested
by implementing it in three participating primary care sites and two
specialty clinics. We expect that the lessons learned from this
evaluation will provide a model and tools that can later easily be
tested and applied to other sites and specialties in the BMC system and
provide lessons learned to other systems seeking to sustainably improve
their referral systems.
This project 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; clinical practice, including primary
care and practice-oriented research; and health care costs,
productivity, organization, and market forces. See 42 U.S.C.
299a(a)(l), (4) and (6).
The overall aims of the evaluation are to provide a rigorous
assessment of the success of the redesigned referral system in meeting
its improvement goals and to gain an understanding of the
implementation of the redesigned system.
Method of Collection
This evaluation will include the following data collections:
[ballot] Medical record data will be used to analyze aspects of the
referral process, such as percentage of items on referral forms filled
in, proportion of specialty appointments made, time between referral
and initial specialty appointment. Patients' personal health data will
not be analyzed. The medical record data will be used to measure both
the fidelity of the redesigned system within the practices and success
in meeting redesign improvement goal (outcome) indicators. The medical
record data will be extracted by project staff and will not impose a
burden on the participating health care sites.
[ballot] Patient satisfaction survey will be administered to
selected patients twice during the project. The questionnaire will be
designed to assess patient experience in the referral system. Only
patients with referrals to obstetrics or gastroenterology specialists
will receive the questionnaire. These two questionnaires are
essentially identical and vary only by the type of specialist seen; for
the purpose of this clearance request they are treated as identical.
Results from the first survey will provide baseline data; results from
the second survey will provide the basis for assessing change over time
and fidelity to the new system design.
[ballot] Focus groups with providers, clinical staff and
administrative staff will be conducted in each primary care site and in
each specialty practice. The group sessions will pursue three topics:
the extent to which the new system is being used as intended; the
perceived effectiveness of the new system as implemented; and the
organization and culture of the clinical setting. Themes from the focus
groups will be used to assess fidelity of implementation, performance
outcomes and factors affecting fidelity and outcomes.
[ballot] Implementation logs and meeting notes kept by the project
team throughout the redesign implementation will document the
implementation process, including factors affecting the process,
challenges encountered, and strategies for dealing with the challenges.
This component of the evaluation will not impose a burden on the
participating health care sites.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
respondents' time to participate in this two year evaluation. The
patient satisfaction survey questionnaire will be completed by a total
of 600 patients prior to the referral process redesign and 600 patients
after the completion of the redesign (Exhibit 1 shows 300 per year).
The questionnaire is estimated to take 6 minutes to complete. Focus
groups will be conducted with about 21 clinical staff at each of the 3
primary care sites and 2 specialty care sites (Exhibit 1 shows 2.5
sites per year). Each focus group session will last about 45 minutes.
The total annualized burden is estimated to be 99 hours.
Exhibit 2 shows the estimated annualized cost burden associated
with the respondents' time to participate in this project. The total
annualized cost burden is estimated to be $2,620.
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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Patient satisfaction survey.................... 300 2 6/60 60
Focus groups................................... 2.5 21 45/60 39
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Total...................................... 302.5 na na 99
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[[Page 9615]]
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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Patient satisfaction survey.................... 300 60 $19.29 $1,157
Focus groups................................... 2.5 39 37.50 1,463
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Total...................................... 302.5 99 na 2,620
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* The hourly wage for the patient surveys is based on the national average wage. The hourly wage for the focus
groups is based upon the weighted mean of the average wages for physicians ($58.76, n=45), clinical
administrative staff ($17.64, n=30) and other clinical staff ($25.48, n=30). National Compensation Survey:
Occupational Wages in the United States, U.S. Department of Labor, Bureau of Labor Statistics. June 2007,
Summary 07-03, http://www.bls.gov/ncs/ocs/sp/ncblO9lO.pdf. Accessed December 10, 2008.
Estimated Annual Costs to the Federal Government
Exhibit 3 shows the estimated total and annualized cost for this
two-year evaluation. The total cost is $155,110 and includes $23,267
for project development, $32,573 for data collection activities,
$31,022 for data processing and analysis, $15,511 for the publication
of results, $12,408 for project management and $40,329 for overhead.
Exhibit 3--Estimated Total and Annualized Cost
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Annualized
Cost component Total cost cost
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Project Development........................... $23,267 $11,633
Data Collection Activities.................... 32,573 16,287
Data Processing and Analysis.................. 31,022 15,511
Publication of Results........................ 15,511 7,756
Project Management............................ 12,408 6,204
Overhead...................................... 40,329 20,164
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Total..................................... 155,110 77,555
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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, quality improvement and 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: February 24, 2009.
Carol M. Clancy,
Director.
[FR Doc. E9-4515 Filed 3-4-09; 8:45 am]
BILLING CODE 4160-90-M