10900 Federal Register / Vol. 76, No. 39 / Monday, February 28, 2011 / Notices 

CWFcomments@cdc.gov. Written 

responses should be addressed to the 

Department of Health and Human 

Services, Centers for Disease Control 

and Prevention, CWF Comments, 

Division of Oral Health, National Center 

for Chronic Disease Prevention and 

Health Promotion (NCCDPHP), 4770 

Buford Highway, NE., MS F–10, Atlanta, 

GA 30341–3717. 

FOR FURTHER INFORMATION CONTACT: 

Barbara F. Gooch, Associate Director for 

Science (Acting), 770–488–6054, 

CWFcomments@cdc.gov, Division of 

Oral Health, National Center for Chronic 

Disease Prevention and Health 

Promotion (NCCDPHP), Centers for 

Disease Control and Prevention, 4770 

Buford Highway, NE., MS F–10, Atlanta, 

GA 30341–3717. 

SUPPLEMENTARY INFORMATION: The 

proposed recommendation was 

published in the Federal Register on 

January 13, 2011 (Volume 76, Number 9, 

page 2383) with a deadline for written 

comments of February 14, 2011. The 

proposed recommendation will update 

and replace the 1962 U.S. Public Health 

Service Drinking Water Standards 

related to recommendations for fluoride 

concentrations in drinking water. The 

U.S. Public Health Service 

recommendations for optimal fluoride 

concentrations were based on ambient 

air temperature of geographic areas and 

ranged from 0.7–1.2 mg/L. 

HHS proposes to update and replace 

these recommendations because of new 

data that address changes in the 

prevalence of dental fluorosis, fluid 

intake among children, and the 

contribution of fluoride in drinking 

water to total fluoride exposure in the 

United States. As of December 31, 2008, 

the Centers for Disease Control and 

Prevention (CDC) estimated that 16,977 

community water systems provided 

fluoridated water to 196 million people. 

Since the proposed recommendation 

was published the Department has 

received a request to extend the 

comment period by an additional 60 

days to allow sufficient time for a full 

review of the proposed action, including 

potential economic and health impacts. 

HHS is committed to affording the 

public a meaningful opportunity to 

comment on the proposed 

recommendation and supporting 

rationale and welcomes comments. 

Dated: February 17, 2011. 

Kathleen Sebelius, 

Secretary. 

[FR Doc. 2011–4343 Filed 2–25–11; 8:45 am] 

BILLING CODE 4150–28–P 

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. 

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: 

‘‘Comparative Effectiveness Research— 

Continuing Education.’’ In accordance 

with the Paperwork Reduction Act, 44 

U.S.C. 3501–3521, AHRQ invites the 

public to comment on this proposed 

information collection. 

DATES: Comments on this notice must be 

received by April 29, 2011. 

ADDRESSES: Written comments should 

be submitted to: Doris Lefkowitz, 

Reports Clearance Officer, AHRQ, by email 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 

Comparative Effectiveness Research— 

Continuing Education 

Previous dissemination efforts in 

health care research and evidence 

through comparative effectiveness 

funded by the Federal Government have 

largely been focused in academic 

settings, rather than among physicians 

and clinicians in health care delivery 

settings. This project implements and 

evaluates methods that extend beyond 

the academic setting to engage the target 

audiences in the health care 

environment where decisions are 

typically made. 

Most clinicians are required to 

complete continuing medical education 

(CME) accepted by accrediting 

organizations recognized by State 

medical boards. Over sixty boards 

require anywhere from 12 CME credits 

to 50 CME credits per year for a 

clinician to retain their State licensure. 

(State Medical Licensure Requirements 

and Statistics, 2010, http://www.amaassn.org/ama1/pub/upload/mm/40/ 

table16.pdf.) AHRQ currently provides 

CME credits on some of its comparative 

effectiveness research reviews; however, 

these CME credits are applicable to 

physicians only and AHRQ is not 

conducting any follow-up surveys with 

physicians on these CME activities to 

ascertain the impact on physician 

behavior. AHRQ is expanding its 

continuing education to include nurses, 

nurse practitioners, physician assistants, 

medical assistants, pharmacists, 

respiratory therapists, and other allied 

health professionals, as well as 

physicians. In addition, AHRQ wants to 

assess the impact continuing education 

has on clinician behavior, its perceived 

value, and whether or not education on 

comparative effectiveness research 

made a difference in a clinician’s 

confidence in applying comparative 

effectiveness research in practice, 

understanding the application of such 

research, and improved ability to 

counsel patients on treatment and 

management alternatives. 

Dissemination of clinical and research 

findings to clinicians varies in 

approach, methods and by target 

audience. Highly technical and 

scientific publications are peer reviewed 

and serve to validate the methods, 

calculations, analysis and conclusions 

of studies and research. Typically, 

scientific journals have a narrowly 

defined readership and information 

regarding clinical application of 

findings is not part of the criteria for 

manuscript acceptance and publication. 

AHRQ complies with the journal 

guidelines when submitting 

manuscripts regarding comparative 

effectiveness research (CER) information 

for publication in the Annals of Internal 

Medicine. However, it is nearly 

impossible to discern whether the 

manuscript was read, its effect on the 

reader, and the likelihood that the 

reader will utilize the information. 

Accredited education is widely 

accepted as a method for dissemination 

of research findings and is provided in 

various ways, including online, on site, 

and through audio and video 

presentations. To earn credit for 

participation, clinicians must provide 

contact information, allowing the 

possibility of follow-up data collections 

regarding behaviors, attitudes and 

performance information about the 

participant. AHRQ has also provided 

accredited education as a method to 

disseminate CER findings, and with this 

project, has reaffirmed the value of CME 

in dissemination of CER findings and 

expanded the commitment to provide 


srobinson on DSKHWCL6B1PROD with NOTICES
Federal Register / Vol. 76, No. 39 / Monday, February 28, 2011 / Notices 10901 

accredited education for multiple health 

care disciplines. 

The goal of this project is to enhance 

awareness of comparative effectiveness 

research among clinicians and measure 

the value and impact of these efforts. 

This study is being conducted by 

AHRQ through its contractor, PRIME 

Education, Inc., pursuant to AHRQ’s 

statutory authority to conduct and 

support research on healthcare and on 

systems for the delivery of such care, 

including activities with respect to: the 

quality, effectiveness, efficiency, 

appropriateness and value of healthcare 

services; quality measurement and 

improvement; and clinical practice. 42 

U.S.C. 299a(a)(1), (2) and (4). 

Method of Collection 

To achieve this project’s goal, the 

following activities and data collections 

will be implemented: 

1. Provide continuing medical 

education (CME) or continuing 

education units (CE/CEU) through the 

appropriate accrediting organizations by 

providing 15 multimedia online 

continuing education modules per year 

for 3 years, on specific comparative 

effectiveness research reports and 

provide quantitative and qualitative 

metrics about usage of these programs 

by physicians, pharmacists, nurses, 

nurse practitioners, physician assistants, 

medical assistants, allied health 

professionals, and other clinicians. This 

activity is designed to raise awareness of 

and utility of comparative effectiveness 

research by providing free and easy 

access to clinician guides and consumer 

guides for clinicians and their patients/ 

families to assist in making informed 

decisions about heath care. 

The following monthly utilization 

rates for the online CME/CE/CEU 

activities will be collected: the number 

of CME/CE/CEU certificates issued, 

monthly participation statistics, and the 

number of clinician and consumer 

guides ordered. Because all of the CME/ 

CE/CEU activities are online, the 

utilization rates are automatically 

collected by the contractor’s computer 

when the health care professional 

registers for the activity, participates in 

the online education, requests 

continuing education credit for the 

activity, and orders clinician and 

consumer guides. Therefore, this 

activity does not require OMB 

clearance. 

2. CME/CE/CEU registration data is 

provided by the health care professional 

when he or she logs on and registers for 

a course. The health care professional 

would key in their name, e-mail 

address, address (selecting either their 

home or business address), telephone 

number, type of discipline, and their 

practice setting. This data is collected to 

ensure that the health care professional 

receives CME/CE/CEU credit for the 

courses that he or she takes and will be 

used to implement the AI–IRQ Online 

Continuing Education Participant 

Evaluation described below. 

3. AHRQ Online Continuing 

Education Participant Evaluation to 

evaluate the effectiveness and impact of 

the CME/CE/CEU modules at 60 days, 6 

months and 1 year after completion of 

the module (see Attachment B). The 

purpose of this evaluation is to assess 

the clinicians’ confidence level in 

applying comparative effectiveness 

research, their understanding of the 

research, how valuable the research is to 

the clinician and their intent to change 

their practice based on this research. 

Evaluation questions have been 

developed based upon established 

conceptual frameworks and principles 

of adult learning. 

Data collected will be used to assess 

the utility and effectiveness of the 

educational module in increasing 

awareness and utility of information 

provided in comparative effectiveness 

research. Data will provide useful 

quantitative arid qualitative metrics 

which AHRQ can use to measure the 

outcomes of the project. Moreover, these 

metrics will enable AHRQ to identify 

new potential barriers that may thwart 

the outcome—lending important 

information regarding future 

educational needs. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden hours for the 

respondents’ time to participate in this 

research. The AHRQ Online Continuing 

Education Participant Evaluation will be 

completed at 3 different points in time 

after completion of the CME/CE/CEU 

education module. The CME/CE/CEU 

registration data is collected for an 

estimated 1,500 health care 

professionals and takes approximately 5 

minutes. The same estimated 1,500 

health care professionals will complete 

the evaluation 3 times each year, which 

takes about 3 minutes to complete. The 

total annual burden is estimated to be 

350 hours. 

Exhibit 2 shows the estimated annual 

cost burden to respondents, based on 

their time to participate in surveys for 

each CME/CE/CEU module. The annual 

cost burden is estimated to be $16,290. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS PER MODULE

Form name Number of 

respondents 

Number of responses per 

respondent 

Hours per 

response 

survey 

Total 

burden 

hours 

AHRQ Online Continuing Education CME/CE/CEU Registration Data ........... 1,500 1 5/60 125 

AHRQ Online Continuing Education Participant Evaluation ........................... 1,500 3 3/60 225 

Total .......................................................................................................... 3,000 na na 350 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN PER MODULE

Form name Number of 

respondents 

Total 

burden 

hours 

Average 

hourly 

wage rate* 

Total 

cost 

burden 

AHRQ Online Continuing Education CME/CE/CEU Registration Data ........... 1,500 125 $46.54 $5,818 

AHRQ Online Continuing Education Participant Evaluation ........................... 1,500 225 46.54 10,472 

Total .......................................................................................................... 3,000 350 na $16,290 

* Based upon the mean of the average hourly wages for Physicians (29–1069; $83.59), Pharmacists (291051; $51.27), Physician Assistants 

and Nurse Practitioners (29–1071; $40.78), Registered Nurses (291111; $31.99) and Healthcare Practitioners (29–9099; $25.05), National Compensation Survey: Occupational wages in the United States May 2009, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’ 


srobinson on DSKHWCL6B1PROD with NOTICES
10902 Federal Register / Vol. 76, No. 39 / Monday, February 28, 2011 / Notices 

Estimated Annual Costs to the Federal 

Government 

Exhibit 3 shows the total and 

annualized cost for the 45 CME/CE/CEU 

modules (15 per year for 3 years). The 

total cost is estimated to be $3,963,150. 

EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST

Cost component Total cost Annualized cost 

Development of CME/CE/CEU Module ....................................................................................................... $2,256,300 $752,100 

Module Accreditation ................................................................................................................................... 900,000 300,000 

Module Dissemination ................................................................................................................................. 450,000 150,000 

Evaluation instrument development and dissemination, data collection, processing and analysis ............ 356,850 118,950 

Total ...................................................................................................................................................... $3,963,150 $1,321,050 

Request for Comments 

In accordance with the Paperwork 

Reduction Act, 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 

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 15, 2011. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2011–4130 Filed 2–25–11; 8:45 am] 

BILLING CODE 4160–90–M 

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. 

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: 

‘‘Improving Patient Safety System 

Implementation for Patients with 

Limited English Proficiency.’’ 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 December 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 March 30, 2011. 

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 email at OIRA_submission@omb.eop.gov 

(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 

doris.lefkowitz@AHRQ.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

Improving Patient Safety System 

Implementation for Patients With 

Limited English Proficiency 

According to the 2009 American 

Community Survey (U.S. Census 

Bureau), approximately 57 million 

people—20% of the U.S. population— 

speak a language other than English at 

home. Of that number, approximately 

24 million (8.6% of the U.S. population) 

are defined as having Limited English 

Proficiency (LEP), meaning that they 

report speaking English less than ‘‘very 

well.’’ Recent research suggests that 

adverse events affect LEP patients more 

severely than they affect Englishspeaking patients. In addition to 

linguistic barriers, LEP patients often 

face cultural barriers to care and low 

health literacy as well. 

AHRQ proposes to develop a new 

training program to improve patient 

safety system implementation for 

patients with limited English 

proficiency. The new training program 

is designed as a continuing education 

module within the TeamSTEPPS 

system. TeamSTEPPS is an evidencebased framework to optimize team 

performance across the healthcare 

delivery system with the goal of 

improving patient safety. This system 

has been successfully implemented in 

numerous hospitals across the United 

States. The TeamSTEPPS curriculum is 

an easy-to-use comprehensive 

multimedia kit that includes modules in 

text and presentation format, video 

vignettes to illustrate key concepts, and 

workshop materials, including a 

supporting CD and DVD, on change 

management, coaching, and 

implementation. Portions of the training 

module may also be useful for hospitals 

that have not implemented 

TeamSTEPPS. The new training module 

will show how TeamSTEPPS principles 

can be better implemented to improve 

the safety of patients with LEP. 

AHRQ proposes to field-test this 

module by conducting case studies of its 

implementation in three hospitals. The 

primary goals of this field test are to 

identify needed changes in the training 

module content or format to increase the 

feasibility of implementation and 

improve module outcomes including 

audience response, learning, adoption of 

recommended team behaviors, and 

improved outcomes for LEP patients. 

Patient outcome measures for this 

project include the patient’s access to an 

interpreter and how well they 


srobinson on DSKHWCL6B1PROD with NOTICES