Federal Register / Vol. 79, No. 131 / Wednesday, July 9, 2014 / Notices 38901 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Data collection method or project activity Number of 

respondents 

Total burden 

hours 

Average hourly wage rate * Total cost 

burden 

1. Hospital Informed Consent Baseline and Final Assessment ...................... 20 40 $42.78 $1,711 

2a. Frontline Staff Pre-/Post-Training Quiz ..................................................... 512 341.33 33.62 11,476 

2b. Hospital Leader Pre-/Post-Training Quiz ................................................... 26 17.33 51.95 900 

3. Monthly Check-in ......................................................................................... 20 60 42.78 2,567 

4. Frontline Clinical Staff Survey ..................................................................... 512 128 33.62 4,303 

5a. Interview—Clinical Staff ............................................................................. 48 48 33.62 1,614 

5b. Interview—Hospital Leaders ...................................................................... 24 24 51.95 1,247 

6. Rapid Feedback Patient Survey .................................................................. 320 26.67 22.33 596 

7. Secondary data ........................................................................................... 4 20 42.78 856 

Total .......................................................................................................... ........................ ........................ ........................ 25,270 

The average hourly wage rate of 

$42.78 for the informed consent 

baseline, readiness assessment, and 

monthly check-in was calculated based 

on the 2013 average of the mean hourly 

wage rate for healthcare practitioners 

and medical occupations (all 

professions) of $33.62 and mean hourly 

wage rate for medical and health 

services managers, $51.95. 

The average hourly rate of $33.62 of 

hospital staff pre- and post-training quiz 

and in-depth interviews was calculated 

based on the 2013 average of the mean 

hourly wage rate for healthcare 

practitioners and medical occupations 

(all professions), $33.62. 

The average hourly rate of $51.95 for 

hospital leaders pre- and post-training 

quiz and in-depth interview was 

calculated based on the 2013 mean 

hourly wage rate for medical and health 

services managers, $51.95. 

The average hourly wage rate for 

patients of $22.33 was calculated on the 

2013 mean hourly wage rate for all 

occupations. Mean hourly wage rates for 

these groups of occupations were 

obtained from the Bureau of Labor & 

Statistics on ‘‘Occupational 

Employment and Wages, May 2013’’ 

found at the following URL: http://

www.bls.gov/oes/current/oes_

nat.htm#b29-0000.htm. 

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 health care 

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: June 25, 2014. 

Richard Kronick, 

AHRQ Director. 

[FR Doc. 2014–15807 Filed 7–8–14; 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: ‘‘Taking 

Efficiency Interventions in Health 

Services Delivery to Scale.’’ In 

accordance with the Paperwork 

Reduction Act of 1995, AHRQ invites 

the public to comment on this proposed 

information collection. 

This proposed information collection 

was previously published in the Federal 

Register on April 8th, 2014, and 

allowed 60 days for public comment. No 

comments were 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 August 8, 2014. 

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.lefkowitz@ahrq.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

Taking Efficiency Interventions in 

Health Services Delivery to Scale 

The primary care workforce is facing 

imminent clinician shortages and 

increased demand. With the 

implementation of the Affordable Care 

Act (ACA), Federally Qualified Health 

Centers (FQHCs) are expected to play a 

major role in addressing the large 

numbers of people who become eligible 

for health insurance as well as continue 

in their role as safety net providers. 

Thus, understanding new models of 

service delivery and improving 

efficiency within FQHCs is of national 

policy import. The proposed data 

collection supports the goal of 

developing a more efficient FQHC 

service delivery model through studying 

outcomes associated with a ‘‘delegate 

model,’’ which is designed to improve 

provider and team efficiency, and the 

spread of this model throughout a large 

FQHC. 

Recent models of practice 

transformation have documented the 

use of an Organized Team Model that 

distributes responsibility for patient 

care among an interdisciplinary team, 

thereby allowing physicians to manage 

a larger panel size while practicing high 

quality care. The delegate model 

requires that all team members perform 


sroberts on DSK5SPTVN1PROD with NOTICES
38902 Federal Register / Vol. 79, No. 131 / Wednesday, July 9, 2014 / Notices 

at the top of their skill level, and that 

tasks currently performed by clinicians 

are delegated to non-clinician team 

members in a safe and effective manner. 

Researchers at the University of 

California, San Francisco have 

estimated that delegation may allow 

physicians to increase their panel size 

by shifting tasks to non-physician team 

members. More specifically, if portions 

of preventive and chronic care services 

are delegated to non-physicians, 

primary care practices can meet 

recommended quality and care 

guidelines while maintaining panel 

sizes with a limited primary care 

physician workforce. This study will 

examine the real-world implementation 

of such a model in order to build 

evidence of whether such delegation 

can achieve the predicted increases in 

panel sizes. 

AHRQ is working with John Snow, 

Inc. (JSI) and its partner, Penobscot 

Community Health Center (PCHC), to 

evaluate the effectiveness and spread of 

a delegate model in 5 of PCHC’s 15 

primary care service sites. The model 

will be spread from an initial pilot 

physician-medical assistant team to 

other clinics, as well as to other teams 

within each clinic. PCHC is an FQHC 

located in Bangor, Maine that serves 

northeastern Maine. 

Currently, PCHC’s primary care 

providers (PCPs, which include medical 

doctors, osteopaths, nurse practitioners, 

and physician assistants) each work 

with a Medical Assistant (MA). Under 

the delegate model, a pair of PCPs will 

be assigned an ‘‘administrative’’ MA to 

enhance their team. This position will 

enable shifting of responsibilities among 

the team, with the intent of relieving the 

PCPs of administrative tasks and 

incorporating new tasks that will 

enhance team efficiency. Examples of 

tasks that an administrative MA may 

take on include standardized 

prescription renewals, schedule 

management, in-box management, 

scribing, pre-visit planning with preappointment laboratory tests, and 

identification of patients for ancillary 

referrals (e.g., behavioral health and 

case management). 

This study has the following goals: 

(1) To evaluate the spread and 

effectiveness of the delegate model in 

five of PCHC’s primary care sites; 

(2) To evaluate the influence of the 

delegate model on provider satisfaction, 

team functioning, and patient 

satisfaction; 

(3) To assess the contextual factors 

influencing the above outcomes; and 

(4) To disseminate findings. 

This study is being conducted by 

AHRQ through its contractor, JSI, 

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 the quality, 

effectiveness, efficiency, 

appropriateness and value of health care 

services and with respect to quality 

measurement and improvement. 42 

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

Method of Collection 

AHRQ seeks approval for the 

following data collection activities: 

• Team Survey that will be 

disseminated to all members of both 

delegate and non-delegate primary care 

teams to assess job satisfaction and team 

functioning in all participating sites at 

two points in time. 

• Key Informant Interviews 

conducted with staff in each of the 

participating sites during two rounds of 

site visits, with key informants to 

include the Medical Director, Practice 

Director, members of primary care teams 

implementing the delegate model, and 

ancillary staff. A condensed version of 

the interview will be used for a 

conference call with each participating 

site’s Medical Director and Practice 

Director as an interim activity between 

the two site visits. 

The information yielded from this 

study is expected to inform a wide cross 

section of audiences and stakeholders 

about provider efficiency, practice 

redesign, team-based care, workforce 

strategies, and spread of an innovation. 

This study is not intended to make 

broad generalizations about the 

effectiveness of the delegate model of 

care, but rather to build initial evidence 

about this promising new model, its 

ability to increase panel size in FQHCs, 

and provide guidance on how similar 

models might be spread and evaluated. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden for the respondents’ 

time to participate in this research. 

Information will be collected through an 

internet-based team survey and inperson and telephone interviews. Note 

that some respondents may be doublecounted, so the total number of 

respondents may be less than 80. For 

example, a respondent may fill out a 

survey as well as participate in a phone 

interview. 

Exhibit 2 shows the estimated 

annualized cost burden associated with 

the respondents’ time to participate in 

this research. The total annual cost 

burden is estimated to be $25,151. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Team Survey: 

–Providers ................................................................................................. 21 2 15/60 11 

–Other Clinical Staff ................................................................................. 34 2 15/60 17 

Total ................................................................................................... 55 2 15/60 28 

Key Informant Interviews (Site visits): 

–Medical Director ...................................................................................... 2 2 30/60 2 

–Practice Director ..................................................................................... 2 2 30/60 2 

–Providers ................................................................................................. 5 2 30/60 5 

–Other Clinical Staff ................................................................................. 10 2 30/60 10 

Total ................................................................................................... 19 2 30/60 19 

Key Informant Interviews (Phone calls): 

–Medical Director ...................................................................................... 3 1 1 3 

–Practice Director ..................................................................................... 3 1 1 3 


sroberts on DSK5SPTVN1PROD with NOTICES
Federal Register / Vol. 79, No. 131 / Wednesday, July 9, 2014 / Notices 38903 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS—Continued 

Form name Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Total ................................................................................................... 6 1 1 6 

Total ........................................................................................... 80 na na 53 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Form name Number of 

respondents 

Total burden 

hours 

Average hourly 

wage rate * 

Total cost 

burden 

Team Survey: 

—Providers ............................................................................................. 21 11 a $62 .13 14,352 

—Other Clinical Staff .............................................................................. 34 17 b 14 .69 8,491 

Total ................................................................................................. 55 28 na 22,843 

Key Informant Interviews (Site Visit): 

—Medical Director .................................................................................. 2 2 c 92 .08 368 

—Practice Director ................................................................................. 2 2 d 47 .34 189 

—Providers ............................................................................................. 5 2 a 62 .13 621 

—Other Clinical Staff .............................................................................. 10 2 b 14 .691 294 

Total ................................................................................................. 19 8 na 1,472 

Key Informant Interviews (Phone calls): 

—Medical Director .................................................................................. 3 2 c 92 .08 552 

—Practice Director ................................................................................. 3 2 d 47 .34 284 

Total ................................................................................................. 6 4 na 836 

Total ......................................................................................... 80 na na 25,151 

* National Compensation Survey: Occupational wages in the United States May 2012, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’ aBased on the average mean wages for three categories of primary care provider ($92.08—MDs; $44.45 PAs; and $43.97—NPs). 

bBased on the mean wage of Medical Assistants. 

cBased on the mean wages for MDs. 

dBased on the mean wages for Medical and Health Services Managers. 

eBased on the mean wages for Data Analyst (Computer and Information Analyst). 

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 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 OMB approval of the 

proposed information collection. All 

comments will become a matter of 

public record. 

Dated: June 25, 2014. 

Richard Kronick, 

AHRQ Director. 

[FR Doc. 2014–15806 Filed 7–8–14; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Comment Request 

Proposed Projects 

Title: Annual Statistical Report on 

Children in Foster Homes and Children 

in Families Receiving Payment in 

Excess of the Poverty Income Level 

From a State Program Funded Under 

Part A of Title IV of the Social Security 

Act. 

OMB No.: 0970–0004. 

Description 

The Department of Health and Human 

Services is required to collect these data 

under section 1124 of Title I of the 

Elementary and Secondary Education 

Act, as amended by Public Law 103– 

382. The data are used by the U.S. 

Department of Education for allocation 

of funds for programs to aid 

disadvantaged elementary and 

secondary students. Respondents 

include various components of State 

Human Service agencies. 

Respondents 

The 52 respondents include the 50 

States, the District of Columbia, and 

Puerto Rico. 


sroberts on DSK5SPTVN1PROD with NOTICES