[Federal Register: March 31, 2009 (Volume 74, Number 60)]
[Notices]
[Page 14560-14562]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr31mr09-67]
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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: ``CAHPS Field Test of Proposed Health Information Technology
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 June 1, 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
``CAHPS Field Test of Proposed Health Information Technology Questions
and Methodology''
The Consumer Assessment of Healthcare Providers and Systems
(CAHPS[supreg]) 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 CAHPS[supreg]
program was designed to:
Make it possible to compare survey results across sponsors
and over time;
and
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 and meet the
various needs of health care consumers, purchasers, health plans,
providers, and policymakers. Based on the literature review and an
assessment of currently available survey instruments, AHRQ identified
the need to develop a new health information technology module of the
CAHPS[supreg] survey. The intent of the planned module is to examine in
greater detail than previously patients' perspective on health
information technology use by their health care professionals. The
intent of the new module is to provide information to clinicians, group
practices, health plans, and other interested parties regarding the
impact of the use of health information technology on patients'
experiences with care. The set of questions about health information
technology will be tested as a part of CAHPS[reg] Clinician & Group
Survey, Adult Primary Care Questionnaire.
This study, funded through cooperative agreements with RAND and
Harvard, 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 (1) the
quality, effectiveness, efficiency, appropriateness and value of health
care services and (2) health care
[[Page 14561]]
technologies, facilities and equipment. See 42 U.S.C. 299a(a)(1) and
(5).
This study is a one-time field test to be conducted in calendar
year 2009. The field test to be conducted under this request will be
done for the following purposes:
a. Analysis of revised item wording--Assess candidate wordings for
survey items
b. Mode Analysis--Evaluate the equivalence of items administered by
mail, telephone, and internet; compare the characteristics and
responses of respondents who complete the survey by different modes of
administration.
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 and
shortening of questionnaires based on the assessment of the reliability
and validity of survey items and composites.
The end result will be a data collection related to the assessment
of patients' perspective on how well health information technology is
being used by health care professionals. The field testing will ensure
that the future data collection yields high quality data and to ensure
a minimization of respondent burden, increase agency efficiency, and
improve responsiveness to the public. The survey items will be added to
currently available CAHPS[reg] surveys and will provide a venue to
clinicians and practitioners to verify the quality of their services.
Method of Collection
Respondents will be selected from four purposively chosen sites
(health care providers and health insurance plans) that have
implemented health information technology systems, such as electronic
health records (EHRs) and electronic prescription refills, that are
used by sufficient numbers of enrollees (i.e., at least 2400 enrollees
per site). From each site the potential respondent universe will be
patients who have been receiving care from a clinician at the health
provider for at least one year prior to the survey and who have used
one or more features of the health providers' EHR system. EHR systems
managers have the ability to track which patients log on to the system,
and which features (e.g., examine lab results, request prescription
refill, etc.) the patients used. The sample selection at each site will
be carried out jointly by senior leadership at the site (e.g., chief
information officer) and a survey vendor experienced in conducting the
CAHPS survey. We will ask the sites to provide a list of their
enrollees who have seen a provider in the last 12 months and who have
logged onto the EHR system in the last 12 months. We will randomly
select a sample of these enrollees for the field test. We will use
common statistical techniques to select the sample, e.g., computerized
random number generation applied to a list of enrollees. When possible,
we will stratify the enrollees at a site based on extent of HIT
exposure to ensure a mix of different enrollees in the study (e.g.,
enrollees who use many HIT functions versus those who use few HIT
functions). Institutional Review Boards (IRBs) at Harvard and RAND
evaluated the study to ensure proper protection of patients' right to
privacy and confidentiality as well as avoidance of harm. The study
received approvals from both IRBs.
The draw will be a sample large enough to yield approximately 4,800
respondents.
Because we are assuming a 50% response rate, we will draw
approximately 9,600 patients to achieve our total of 4,800 respondents.
Sites to be selected will meet the following requirements:
As much geographic distribution as possible
Substantial number of patients with exposure to health
information technology
We anticipate a mixed mail-telephone mode of data collection which
will include the following steps:
Mailing an advance notification letter
Mailing of the questionnaire and cover letter
Postal card reminder
A second mailing of the questionnaire to non-respondents
Minimum of six telephone calls to every mail non-
respondent approximately two weeks after the final mailing to complete
a telephone interview
We will also administer the survey by Internet to some of the study
participants. For those assigned to Internet administration an e-mail
invitation will be sent that includes an invitation to participate
along with a URL link to a Web-based survey hosted on a secure server.
Sites will be divided between RAND's Survey Research Group and the
Center for Survey Research, University of Massachusetts, Boston (CSR).
RAND will use the software CfMC to administer the survey, while CSR
will use Snap software.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden for the
respondents' time to participate in this data collection. The
CAHPS[supreg] Clinician & Group Survey, Adult Primary Care
Questionnaire will be completed by about 4,800 persons. 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 a similar, although not
identical, population. The total burden hours are estimated to be 1,600
hours.
Exhibit 2 shows the respondents' cost burden associated with their
time to participate in this data collection. The total cost burden is
estimated to be $31,296.
Exhibit 1--Estimated Annualized Burden Hours
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Number of
Number of responses Hours per Total
Form name respondents per response burden
respondent hours
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CAHPS[supreg] Clinician & Group Survey, Adult Primary Care 4800 1 20/60 1600
Questionnaire..............................................
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Total................................................... 4800 1 na 1600
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Exhibit 2--Estimated annualized cost burden
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Total Average
Form name Number of burden hourly wage Total cost
respondents hours rate * burden
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CAHPS[supreg] Clinician & Group Survey, Adult Primary Care 4800 1600 $19.56 $31,296
Questionnaire..............................................
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Total................................................... 4800 1600 na 31,296
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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 to the Federal Government for developing the Health
Information Technology questions, and testing them within the
CAHPS[supreg] Clinician & Group Survey, Adult Primary Care
Questionnaire, is $780,000, including the cost of reviewing the
literature, conducting focus groups and cognitive interviews, field
testing the instrument, analyzing the data, finalizing the survey,
preparing reports, writing papers for journal submission, and project
management (see Exhibit 3). Data collection will not exceed one year.
Exhibit 3--Estimated Annual Cost
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Cost component Total cost
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Review of literature....................................... $35,000
Focus groups............................................... 60,000
Cognitive interviews....................................... 80,000
Field test................................................. 260,000
Data analyses.............................................. 80,000
Finalize survey............................................ 50,000
Preparation of reports and journal papers.................. 85,000
AHRQ project management.................................... 130,000
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Total.................................................. $780,000
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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 0MB approval of the
proposed information collection. All comments will become a matter of
public record.
Dated: March 20, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9-6956 Filed 3-30-09; 8:45 am]
BILLING CODE 4160-90-M