Federal Register / Vol. 77, No. 37 / Friday, February 24, 2012 / Notices 11117 

• Create and maintain an integrated 

national plan to overcome Alzheimer’s 

disease. 

• Coordinate Alzheimer’s disease 

research and services across all federal 

agencies. 

• Accelerate the development of 

treatments that would prevent, halt, or 

reverse the course of Alzheimer’s 

disease. 

• Improve early diagnosis and 

coordination of care and treatment of 

Alzheimer’s disease. 

• Improve outcomes for ethnic and 

racial minority populations that are at 

higher risk for Alzheimer’s disease. 

• Coordinate with international 

bodies to fight Alzheimer’s globally. 

The law also establishes the Advisory 

Council on Alzheimer’s Research, Care, 

and Services and requires the Secretary 

of HHS, in collaboration with the 

Advisory Council, to create and 

maintain a national plan to overcome 

Alzheimer’s disease (AD). 

On February 22, 2012, HHS released 

a draft National Plan to Address 

Alzheimer’s Disease. The draft National 

Plan has five goals: 

1. Prevent and Effectively Treat 

Alzheimer’s Disease by 2025. 

2. Optimize Care Quality and 

Efficiency. 

3. Expand Supports for People with 

Alzheimer’s Disease and Their Families. 

4. Enhance Public Awareness and 

Engagement. 

5. Track Progress and Drive 

Improvement. 

The draft National Plan includes 

strategies to achieve each goal and 

specific actions that HHS or its federal 

partners will take to drive progress 

towards achieving the goal. 

Sherry Glied, 

Assistant Secretary for Planning and 

Evaluation. 

[FR Doc. 2012–4278 Filed 2–23–12; 8:45 am] 

BILLING CODE 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: ‘‘System 

Redesign for Value in Safety Net 

Hospitals and Delivery Systems.’’ 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 24, 2012. 

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 

email at doris.lefkowitzAAHRQ.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

System Redesign for Value in Safety Net 

Hospitals and Delivery Systems 

This proposed project is a case study 

of 8 safety net (SN) hospitals. The goals 

of the project are to: 

(1) Identify the tools and resources 

needed to facilitate system redesign in 

SN hospitals; and 

(2) Identify any barriers to adoption of 

these in SN environments, or any gaps 

that exist in the available resources. 

These goals are consistent with The 

National Strategy for Quality 

Improvement in Health Care, published 

by the U.S. Department of Health and 

Human Services in March 2011, which 

articulated a need for progress toward 

three goals: (1) Better Care; (2) Healthy 

People/Healthy Communities; and (3) 

Affordable Care. SN hospitals and 

systems are critical to achieving all 

three. SN hospitals are hospitals and 

health systems which provide a 

significant portion of their services to 

vulnerable, uninsured and Medicare 

patients. While all hospitals face 

challenges in improving both quality 

and operating efficiency, safety net (SN) 

hospitals face even greater challenges 

due to growing demand for their 

services and decreasing funding 

opportunities. 

Despite these challenging 

environmental factors, some SN 

hospitals and health systems have 

achieved financial stability and 

implemented broad-ranging efforts to 

improve the quality of care they deliver. 

However, while there have been 

successful quality improvement 

initiatives for SN providers, most 

initiatives aim at specific units within 

large organizations. The improvements 

introduced into these units have not 

often been spread throughout the 

organization. Additionally, these 

improvements often are hard to sustain. 

‘‘System redesign’’ refers to aligned and 

synergistic quality improvement efforts 

across a hospital or health system 

leading to multidimensional changes in 

the management or delivery of care or 

strategic alignment of system changes 

with an organization’s business strategy. 

System redesign, if done successfully, 

will allow SN providers to improve 

their operations, remain afloat 

financially, and provide better quality 

healthcare to vulnerable and 

underserved populations. Resources, as 

defined here, may include learning 

materials and environments developed 

to support, advance, and facilitate 

quality improvement efforts (e.g., tools, 

guides, webinars, learning 

collaboratives, training programs). The 

term ‘‘resources’’ should not be 

interpreted here to imply financial 

support for routine staffing or 

operations of Safety Net systems, but 

may include quality improvement 

grants, fellowships, collaboratives and 

trainings. 

Many tools, guides, and other learning 

environments have been developed to 

support the implementation of 

individual quality improvement 

initiatives. 

However, the development of 

resources to support alignment across 

multiple domains of a health system has 

been limited. Furthermore, the 

applicability of existing resources to SN 

environments is unknown. 

This study is being conducted by 

AHRQ through its contractor, Boston 

University, 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 and with respect to quality 

measurement and improvement. 42 

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

Method of Collection 

To achieve the goals of this project the 

following activities and data collections 

will be implemented: 

(1) In-person interviews will be 

conducted during a 2-day site visit with 

senior medical center leaders, clinical 

managers and staff involved in system 

redesign from each of the 8 participating 

SN hospitals. These interviews may be 

conducted one-on-one or in small 

groups, depending upon the 

participants’ availability. The purpose 


srobinson on DSK4SPTVN1PROD with NOTICES
11118 Federal Register / Vol. 77, No. 37 / Friday, February 24, 2012 / Notices 

of these interviews is to learn directly 

from hospital leadership and staff about 

the resources they have used to support 

and guide their system redesign efforts 

and what, if any, gaps there are in the 

resources available to them. 

(2) Collection of documentation from 

each SN hospital. The documentation to 

be collected includes annual reports, 

performance dashboards, reports on 

specific system redesign and quality 

improvement projects and hospital 

newsletters. The purpose of this task is 

to provide supplementary information 

about the hospitals and their quality 

improvement and system redesign 

efforts. Collection of documentation 

from participating hospitals will allow 

the research team to collect additional 

information that is readily available in 

hospital documents, but may not be 

known or readily accessible to interview 

subjects during their interviews. 

The findings and recommendations 

developed from this project will be 

disseminated through AHRQ networks 

and through our partnership with the 

National Association of Public Hospitals 

and its membership group to ensure that 

findings are reaching administrators at 

public and SN hospitals directly. In 

addition, findings will be published in 

peer-reviewed and trade literatures so 

that they will be available to a wide 

range of SN delivery system managers 

and clinicians for use in hospitals and 

healthcare systems. Findings will be 

presented as illustrative of the issues 

facing SN hospitals engaging in system 

redesign—rather than as representing 

the quantity or distribution of 

conditions and practices within SN 

hospitals. All presentations and 

publications will state the limitations of 

our case-study methodology. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden hours for the 

respondents’ time to participate in this 

data collection. In-person interviews 

will be conducted with a total of 160 

hospital staff members (20 from each of 

the 8 participating SN hospitals) and 

will last about 1 hour. The collection of 

documentation will require 2 hours 

work from 1 staff member at each 

hospital. The total burden is estimated 

to be 176 hours. 

EXHIBIT 1—ANNUALIZED BURDEN HOURS

Data Collection Number of respondents 

Number of responses per 

respondent 

Hours per response Total burden 

hours 

In-person interviews ......................................................................................... 160 1 1 160 

Collection of documentation ............................................................................ 8 1 2 16 

Total .......................................................................................................... 168 n/a n/a 176 

Exhibit 2 shows the estimated 

annualized cost burden associated with 

the respondents’ time to provide the 

requested data. The total cost burden is 

estimated to be $9,242 annually. 

EXHIBIT 2—ESTIMATED ANNUALIZED BURDEN COST

Data Collection Number of respondents 

Total burden 

hours 

Average hourly wage rate * Total cost burden 

In-person interviews ......................................................................................... 160 160 $56.23 $8,997 

Collection of documentation ............................................................................ 8 16 $15.30 $245 

Total .......................................................................................................... 168 176 na $9,242 

* The hourly rate of 56.23 is an average of the clinical personnel hourly wage of $91.10 for physicians and $32.56 for registered nurses, and 

the administrative personnel hourly wage of $45.03 for medical and health services managers. The hourly rate of $15.30 is median hourly rate 

for medical administrative support staff. All hourly rates are based on median salary data provided by the U.S. Bureau of Labor Statistics. 

Estimated Annual Costs to the Federal 

Government 

Exhibit 3 shows the estimated total 

and annualized cost to the government 

for this 3 year project. The total cost is 

$499,877 and includes the cost of data 

collection, data analysis, reporting, and 

government oversight of the contract. 

The costs associated with data 

collection activities are not all for the 

primary data collection of the case 

studies but include the review of 

existing literature and other available 

data sources. 

TABLE 3—COST TO THE FEDERAL GOVERNMENT

Cost component Total cost Annualized 

cost 

Project Development ............................................................................................................................................... $49,161 $16,377 

Data Collection Activities ......................................................................................................................................... 123,478 41,159 

Data Processing and Analysis ................................................................................................................................. 109,433 36,478 

Publication of Results .............................................................................................................................................. 81,836 27,279 

Project Management ................................................................................................................................................ 18,438 6,146 

Overhead ................................................................................................................................................................. 117,531 39,177 

Government Oversight ............................................................................................................................................. 13,710 4,570 

Total .................................................................................................................................................................. 499,877 166,626 


srobinson on DSK4SPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 37 / Friday, February 24, 2012 / Notices 11119 

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, 2012. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2012–4254 Filed 2–23–12; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Request for Nominations of Children’s 

Healthcare Quality Measures for 

Potential Inclusion in the CHIPRA 2013 

Improved Core Set of Health Care 

Quality Measures for Medicaid/CHIP 

AGENCY: Agency for Healthcare Research 

and Quality (AHRQ), HHS. 

ACTION: Notice of Request for measures. 

SUMMARY: Section 401(a) of the 

Children’s Health Insurance Program 

Reauthorization Act of 2009 (CHIPRA), 

Public Law 111–3, amended the Social 

Security Act to enact section 1139A (42 

U.S.C.1320b–9a). Section 1139A(b) 

charged the Department of Health and 

Human Services (HHS) with improving 

pediatric health care quality measures. 

The Agency for Healthcare Research and 

Quality (AHRQ) is soliciting the 

submission of measures of children’s 

healthcare quality for potential 

inclusion in the CHIPRA 2013 Improved 

Core Set of Health Care Quality 

Measures (the ‘‘Improved Core Set’’) for 

potential voluntary use by Medicaid and 

the Children’s Health Insurance 

Program. In addition, CHIPRA 

established the Pediatric Quality 

Measures Program to increase the 

portfolio of measures available to public 

and private purchasers of children’s 

health care services, providers, and 

consumers. HHS anticipates that 

measures ultimately included in the 

Improved Core Set will also be used by 

public and private purchasers to 

measure pediatric healthcare quality. 

AHRQ is interested in information about 

the importance, scientific validity, and 

feasibility of the measures. If a measure 

is selected for inclusion, more 

information, including a copyright 

release (if applicable) and full measure 

specifications would be needed. 

DATES: Please submit materials within 

60 days of publication of this notice. 

ADDRESSES: Electronic submissions are 

encouraged, preferably as an email with 

one or more electronic files in a 

standard word processing format as an 

email attachment. Submissions may also 

be in the form of a letter to: Denise 

Dougherty, Ph.D., Senior Advisor, Child 

Health and Quality Improvement, 

Agency for Healthcare Research and 

Quality, 540 Gaither Rd, Rockville, MD 

20850, Phone: 301–427–1868, Fax: 301– 

427–1562, Email: denise.DOUGHERTY 

@AHRQ.hhs.gov. 

It would be most helpful to the 

Agency if commenters would include 

the following information in their 

response: measure characteristics: 

measure name; measure description; 

denominator statement (if applicable); 

numerator statement (if applicable); data 

sources and exclusions; applicable 

proprietary rights (e.g., patent or data 

rights); any confidentiality or trade 

secret protections; whether the measure 

is part of a measure hierarchy (e.g., a 

collection of measures, a measure set, a 

measure subset as defined at http:// 

www.QUALITYMEASURES.AHRQ.gov/ 

about/hierarchy.aspx); detailed measure 

specifications; importance of the 

measure; settings, services, measure 

domains, and populations addressed by 

the measure; evidence for focus of the 

measure; scientific soundness of the 

measure; results of any efforts to 

demonstrate the capacity of the measure 

to produce results that stratify by race/ 

ethnicity, socioeconomic status, special 

health care need, and/or rurality/ 

urbanicity; feasibility of the measure 

(e.g., availability of data in existing data 

systems); levels at which the measure 

can be aggregated (e.g., State, health 

plan, provider); understandability to 

consumers and providers; health 

information technology readiness and 

sensitivity (e.g., whether the measure 

has been tested in an electronic health 

record or other health information 

technology); followup contact 

information. 

AHRQ would also be interested in a 

summary rationale for why the measure 

should be included in the 2013 

Improved Core Set, taking into account 

a balance among desirable attributes of 

the measure. For example, you may be 

want to describe advantages that this 

measure has over alternative measures 

that were considered by the measure 

developer or advantages that this 

measure has over existing measures. 

FOR FURTHER INFORMATION CONTACT: 

Denise Dougherty, Ph.D., Senior 

Advisor, Child Health and Quality 

Improvement, Agency for Healthcare 

Research and Quality, 540 Gaither Rd, 

Rockville, MD 20850, Phone: 301–427– 

1868, Fax: 301–427–1562, Email: 

denise.DOUGHERTY@AHRQ.hhs.gov. 

SUPPPLEMENTARY INFORMATION: Section 

401(a) of the Children’s Health 

Insurance Program Reauthorization Act 

of 2009 (CHIPRA), Public Law 111–3, 

amended the Social Security Act to 

enact section 1139A (42 U.S.C. 1320b– 

9a). Section 1139A(b) charged the 

Department of Health and Human 

Services (HHS) with improving 

pediatric health care quality measures. 

Since CHIPRA was passed, the Agency 

for Healthcare Research and Quality 

(AHRQ) and the Centers for Medicare & 

Medicaid Services (CMS) have been 

working together to implement selected 

provisions of the legislation related to 

children’s health care quality 

(www.AHRQ.gov/CHIPRA). An initial 

core measure set for voluntary use by 

Medicaid and Children’s Health 

Insurance Programs was posted 

December 29, 2009 (http:// 

www.GPO.gov/fdsys/PKG/FR–2009–12– 

29/html/E9–30802.htm). In February 

2010, CMS released a State Health 

Official letter which outlined the initial 

core measures and how they should be 

reported to CMS. 

Subsequently, AHRQ and CMS 

established the CHIPRA Pediatric 

Quality Measures Program (PQMP) to 

enhance select pediatric quality 

measures and develop new measures as 

needed (http://www.AHRQ.gov/ 

CHIPRA). CHIPRA stipulates that 

improved core measures be identified 

annually, beginning January 1, 2013. 

Under the PQMP, measures are being 

developed and improved by 7 AHRQ– 

CMS Centers of Excellence (http:// 

www.AHRQ.gov/CHIPRA/ 

PQMPFACT.htm). In addition, this 

notice seeks public nominations of 

measures for potential inclusion in 

Improved Core Sets. 


srobinson on DSK4SPTVN1PROD with NOTICES