[Federal Register Volume 75, Number 61 (Wednesday, March 31, 2010)]
[Notices]
[Pages 16129-16132]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-6776]
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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: ``Studying the Implementation of a Chronic Care Toolkit and
Practice Coaching In Practices Serving Vulnerable Populations.'' In
accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-3520, AHRQ
invites the public to comment on this proposed information collection.
This proposed information collection was previously published in
the Federal Register on February 1, 2010 and allowed 60 days for public
comment. One comment was received. The purpose of this notice is to
allow an additional 30 days for public comment.
DATES: Comments on this notice must be received by April 30, 2010.
ADDRESSES: Written comments should be submitted to: AHRQ's OMB Desk
Officer by fax at (202) 395-6974 (attention: AHRQ's desk officer) or by
e-mail at [email protected] (attention: AHRQ's desk
officer).
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
[email protected].
SUPPLEMENTARY INFORMATION:
Proposed Project
Studying the Implementation of a Chronic Care Toolkit and Practice
Coaching In Practices Serving Vulnerable Populations
An important part of AHRQ's mission is to disseminate information
and tools that can support improvement in quality and safety in the
U.S. health care community. This proposed information collection
supports that part of AHRQ's mission by further refining the practice
coaching delivered in conjunction with a previously developed toolkit,
Implementing Integrating Chronic Care and Business Strategies in the
Safety Net: A Toolkit for Primary Care Practices and Clinics. AHRQ
requests that the Office of Management and Budget approve, under the
Paperwork Reduction Act of 1995, AHRQ's intention to collect
information needed to determine whether practice coaching is effective
in facilitating adoption of the Chronic Care Model (CCM) for improving
treatment and management of chronic medical conditions by primary care
physicians, especially those who care for underserved populations. This
project is being conducted pursuant to AHRQ's statutory authority to
conduct and support research on health care and on systems for the
delivery of such care, including activities with respect to quality
measurement and improvement and with respect to clinical practice,
including primary care and practice-oriented research. 42 U.S.C.
299a(a)(2) and (4). This project will be conducted by AHRQ through a
contract with the University of Minnesota.
Although 1,500 physician practices in the U.S. and internationally
have been involved in CCM quality improvement efforts, most patients
still do not receive their chronic care in accordance with CCM. One
factor affecting CCM implementation has been that having teams attend
collaborative meetings (three two-day meetings over a nine-month
period) is burdensome, especially for under-resourced providers. An
attempt to use the Internet as a virtual collaborative met with
disappointing results. Another barrier to adoption of the CCM in
settings that serve vulnerable populations is the scarcity of resources
to implement and sustain the CCM. In 2006 AHRQ contracted with the RAND
Corporation, Group Health's MacColl Institute, and the California
Health Care Safety Net Institute (SNI) to develop a toolkit that
informs safety net providers on how to redesign their systems of care
along the lines of the Chronic Care Model while attending to their
financial realities. The result was Implementing Integrating Chronic
Care and Business Strategies in the Safety Net: A Toolkit for Primary
Care Practices and Clinics. The Toolkit was piloted in two California
safety net clinics. Recognizing that merely distributing the Toolkit
was unlikely to foster adoption of CCM, the intervention included six
months of practice coaching delivered by the MacColl Institute.
Practice Coaches (PC) are health care or related professionals who help
primary care practices in a variety of quality improvement and research
activities. PCs made two site visits to each site and participated in
weekly team meetings by phone. They also interacted with the sites
through e-mail and phone contact.
The lack of documentation available on coaching led to the
development of a practice coaching manual, which was funded by AHRQ
through a contract with the RAND Corporation. Development of the
Coaching Manual entailed conducting a literature review, interviewing
practice coaching experts, and incorporating evaluation results from
the coaching provided in conjunction with the Toolkit. The Coaching
Manual was published in the winter of 2009. The literature review and
interviews revealed that there are a number of different models of
practice coaching. However, knowledge is scant about how practice
coaching is best performed, under what conditions practice coaching is
most successful, and the costs of coaching and being coached. Pilot
testing the Toolkit with a low-intensity practice coaching strategy
proved insufficient to encourage practices to use the Toolkit
independently. The Toolkit was subsequently streamlined based on pilot
sites' reports that the initial Toolkit was not easy to use. This
project will explore the implementation of the revised Toolkit along
with a more intensive practice coaching strategy, providing lessons on
methods to improve chronic care in clinical practices that serve
vulnerable populations.
Method of Collection
This project will include the following data collections:
(1) Key Informant Interviews with providers, staff and practice
coaches from 20 safety net practices that participate in the practice
coaching intervention. These will be used to describe the process and
content of practice coaching, perceived changes from the coaching
intervention at the practice, provider and patient levels, factors that
impeded or facilitated the coaching intervention and implementation of
practice changes
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through the coaching process, overall satisfaction with practice
coaching, and recommendations for improvement.
(2) Primary Care Practice Profile (PCPP). This questionnaire will
be completed by a single individual at each site, either the medical
director or chief administrator, and will provide an overview of each
replication site that will help place intervention activities and
outcomes in context for each site. It covers demographics of patients
served, patient flow, disease health outcomes, most frequent diagnoses,
most frequent referrals, number of staff by discipline, staff and
patient satisfaction, processes of care, and organizational processes.
(3) Physician Practice Connections-Readiness Survey (PPC-RS)--This
questionnaire asks about the presence of 53 practice systems in 5 of
the 6 domains of the Chronic Care Model: Clinical information systems
(information systems, presence of registry or organized database, and
systematic monitoring of patient population); decision support
(clinician reminders and alerts for lab tests, and visits or guidelines
related to individual patient care), delivery system redesign (services
for managing patients with chronic illness involving multiple
clinicians and care between visits), health care organization
(performance tracking and feedback, process of using clinical
information systems to aggregate and report on key indicators, and use
of data for benchmarking performance and informing QI activities), and
clinical quality improvement (presence of formal processes to assess
care, develop interventions, and use data to monitor the effects).
(4) Assessment of Chronic Illness Care (ACIC)--The ACIC is
contained in the Toolkit and yields subscale scores and a total score.
Subscale scores reflect CCM components and include: Community linkages,
self-management support, decision support, delivery system design,
information systems, and organization of care.
(5) Change Process Capability Questionnaire (CPCQ)--The CPCQ
assesses 30 factors and strategies that experienced quality improvement
leaders ranked as most important for successful implementation. A
recent validation study found good predictive validity. Items
correlating with the PPC-RS were eliminated after the initial
validation study so there is little to no overlap across the two
measures. In addition to changes in the content of care (CCM
components), these also include organizational will for change
(Priority) and capacity and skill in the conduct of the actual change
processes and strategies.
(6) Patient Assessment of Chronic Illness Care (PACIC)--The 20-item
PACIC consists of five subscales which assess components of the CCM:
Patient activation, delivery system design/decision support, goal
setting, problem-solving/contextual counseling, and followup and
coordination.
(7) Consumer Assessment of Healthcare Providers and Systems--
Primary Care Adult--This questionnaire assesses patient experiences in
three areas: Getting appointments and healthcare when needed; how well
doctors communicate, and courteous and helpful office staff.
(8) Primary Care Staff Satisfaction Survey--This questionnaire
assesses staff satisfaction with their work environment. It consists of
8 4-point likert scale items and 2 open-ended questions, and was
developed by the Institute for Healthcare Improvement.
(9) Chart Audits--Chart audits will be conducted at baseline, the
end of the 10-month coaching intervention, and at 3-month follow-up to
assess changes in patient care quality over the course of the
intervention. A chart abstraction form will be developed to collect
these data. This data collection will be performed by the project staff
and will not impose a burden on the participating sites. Therefore, OMB
clearance is not required for this data collection.
Clinic staff will be provided with a paper version of the surveys
as well as the option to complete the surveys on line using a secure
on-line survey program. With the exception of the staff surveys, no
special information technology will be used to collect information,
since many of the data collection forms are standardized instruments
available in hard-copy form, and special permission from the developers
would be required to create electronic versions of these forms. The
information collection is a one-time only project; thus, there would be
little benefit in reduced burden from automated information collection
tools for the other instruments.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
respondents' time to participate in this two-year study. Key informant
interviews will be conducted with practice coaches at midpoint in the
intervention and again at the end of the intervention. Key informant
interviews will also be conducted with up to 3 primary care providers
and 2 other staff members from each of the 20 practices (10 per year)
prior to start of the intervention, and again at 3-month follow-up
after the intervention is completed. Each interview takes about 1 hour.
The Primary Care Practice Profile will be administered once and
will be completed by one staff person from each practice and takes 30
minutes to complete. The Physician Practice Connections-Readiness
Survey (PPC-RS) will be completed pre, post and at 3-month follow-up by
three individuals from each of the 20 practices (individuals with the
appropriate knowledge to complete the survey will be identified by the
medical director of each site). It takes 90 minutes to complete. The
Assessment of Chronic Illness Care (ACIC) will be completed by 4 staff
and 4 primary care providers per practice at pre, post and 3-month
follow-up and takes 30 minutes to complete. The Change Process
Capability Questionnaire (CPCQ) will be completed by 4 staff and 4
primary care providers per practice at pre, post and 3-month follow-up
and takes 15 minutes to complete. The Primary Care Staff Satisfaction
Survey (PCSSS) will be completed by 4 staff and 4 primary care
providers per practice at pre, post and 3-month follow-up and takes 15
minutes to complete. The Patient Assessment of Chronic Illness Care
(PACIC) will be completed by 3,000 adult patients (1,500 annually) with
chronic illness and requires 15 minutes to complete. The Consumer
Assessment of Healthcare Providers and Systems--Primary Care Adult
(CAHPS) will be completed by 3,000 adult patients (1,500 annually) with
chronic illness and requires 45 minutes to complete. Both patient
surveys will be administered to adult patients with a chronic disease
who receive care at the practices during a 2-day data collection period
immediately before, immediately after, and at 3-month follow-up. The
surveys will be administered during the post visit period in the wait
room, by a bi-lingual Spanish-English research assistant. The total
annualized burden hours are estimated to be 1,984 hours.
Exhibit 2 shows the estimated annualized cost burden associated
with the respondent's time to participate in this study. The total
annualized cost burden is estimated to be $60,714.
[[Page 16131]]
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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Key informant interviews with practice coaches.. 2 2 1 4
Key informant interviews with providers (3 per 10 6 1 60
practice interviewed twice)....................
Key informant interviews with staff (2 per 10 4 1 40
practice interviewed twice)....................
Primary Care Practice Profile (PCPP)............ 10 1 30/60 5
Physician Practice Connections--Readiness Survey 10 9 1.5 135
(PPC-RS) (3 per practice x 3 times)............
Assessment of Chronic Illness Care (ACIC) (8 per 10 24 30/60 120
practice x 3 times)............................
Change Process Capability Questionnaire (CPCQ) 10 24 15/60 60
(8 per practice x 3 times).....................
Primary Care Staff Satisfaction Survey (PCSSS) 10 24 15/60 60
(8 per practice 3 x times).....................
Patient Assessment of Chronic Illness Care 1,500 1 15/60 375
(PACIC)........................................
Consumer Assessment of Healthcare Providers and 1,500 1 45/60 1,125
Systems--Primary Care Adult (CAHPS)............
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Total....................................... 3,072 na na 1,984
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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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Key informant interviews with practice coaches.. 2 4 $42.00 $168
Key informant interviews with providers......... 10 60 77.64 4,658
Key informant interviews with staff............. 10 40 32.64 1,306
Primary Care Practice Profile (PCPP)............ 10 5 77.64 388
Physician Practice Connections--Readiness Survey 10 135 77.64 10,481
(PPC-RS).......................................
Assessment of Chronic Illness Care (ACIC)....... 10 120 ** 55.14 6,617
Change Process Capability Questionnaire (CPCQ).. 10 60 ** 55.14 3,308
Primary Care Staff Satisfaction Survey.......... 10 60 ** 55.14 3,308
Patient Assessment of Chronic Illness Care 1,500 375 20.32 7,620
(PACIC)........................................
Consumer Assessment of Healthcare Providers and 1,500 1,125 20.32 22.860
Systems--Primary Care Adult (CAHPS)............
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Total....................................... 3,072 1,984 na 60,714
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* Based upon the mean of the average wages, May 2008 National Occupational and Wage Estimates accessed on
December 14, 2009 at: http://www.bls.gov/oes/current/oes_nat.htm#b29-0000.
National Compensation Survey:
** Average for 4 staff ($32.64/hr) and 4 physician clinicians ($77.64/hr).
Estimated Annual Costs to the Federal Government
Exhibit 3 shows the estimated total and annualized cost to conduct
this research. The total cost over two years is estimated to be
$600,000.
Exhibit 3--Estimated Total and Annualized Cost
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Cost component Total cost Annualized cost
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Project Development............... $162,744 $81,372
Data Collection Activities........ 92,994 46,497
Data Processing and Analysis (20%) 92,994 46,497
Publication of Results............ 23,248 11,624
Project Management................ 92,994 46,497
Overhead.......................... 135,026 67,513
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Total......................... 600,000 300,000
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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 healthcare research and healthcare 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
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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: March 19, 2010.
Carolyn M. Clancy,
Director.
[FR Doc. 2010-6776 Filed 3-30-10; 8:45 am]
BILLING CODE 4160-90-M