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[Federal Register Volume 79, Number 131 (Wednesday, July 9, 2014)]
[Notices]
[Pages 38901-38903]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-15806]

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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: ``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

[[Page 38902]]

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 pre-appointment 
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 in-person and 
telephone interviews. Note that some respondents may be double-counted, 
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
----------------------------------------------------------------------------------------------------------------
                                                                     Number of
                    Form name                        Number of     responses per     Hours per     Total burden
                                                    respondents     respondent       response          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
                                                 ---------------------------------------------------------------

[[Page 38903]]

 
        Total...................................               6               1               1               6
                                                 ---------------------------------------------------------------
            Total...............................              80              na              na              53
----------------------------------------------------------------------------------------------------------------

                                   Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
                                                     Number of     Total burden   Average hourly    Total cost
                    Form name                       respondents        hours        wage rate *       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.''
\a\ Based on the average mean wages for three categories of primary care provider ($92.08--MDs; $44.45 PAs; and
  $43.97--NPs).
\b\ Based on the mean wage of Medical Assistants.
\c\ Based on the mean wages for MDs.
\d\ Based on the mean wages for Medical and Health Services Managers.
\e\ Based 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
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