4718 Federal Register / Vol. 79, No. 19 / Wednesday, January 29, 2014 / Notices 

December 6, 2013, the IRS announced 

that as of January 1, 2014, the relocation 

mileage rate would decrease to $0.235 

per mile for the 12-month period ending 

on December 31, 2014. Thus, the 

reimbursement rate for POVs used in 

conjunction with official relocation will 

also be $0.235 for the same period. FTR 

Bulletin 14–04 is attached. FTR Bulletin 

14–04 and all other FTR bulletins may 

be found at www.gsa.gov/

federaltravelregulation. 

DATES: This notice is effective January 

29, 2014 and applies to relocations 

performed on or after January 1, 2014, 

through December 31, 2014. 

FOR FURTHER INFORMATION CONTACT: Mr. 

Ed Davis, GSA, Office of Governmentwide Policy (M), Office of Asset and 

Transportation Management (MA), at 

202–208–7638 or via email at ed.davis@

gsa.gov. Please cite FTR Bulletin 14–04. 

Dated: January 17, 2014. 

Anne E. Rung, 

Associate Administrator, Office of 

Government-wide Policy. 

[FR Doc. 2014–01705 Filed 1–28–14; 8:45 am] 

BILLING CODE 6820–14–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Office of the Secretary 

Office of the Assistant Secretary for 

Financial Resources (ASFR); 

Statement of Organization, Functions, 

and Delegations of Authority 

Part A, Office of the Secretary, 

Statement of Organization, Functions 

and Delegations of Authority for the 

Department of Health and Human 

Services (HHS) is being amended at 

Chapter AM, Office of the Assistant 

Secretary for Financial Resources, as 

last amended at 77 FR 19666–67, dated 

April 2, 2012. This reorganization will 

eliminate the Office of Executive 

Program Information (AMW) within 

ASFR through the following changes: 

A. Under Section AM.10 

Organization, delete the last sentence of 

the section in its entirety and replace 

with the following: 

The office consists of the following 

components: 

• Immediate Office of the Assistant 

Secretary (AM). 

• Office of Budget (AML). 

• Office of Finance (AMS). 

• Office of Grants and Acquisition 

Policy and Accountability (AMT). 

B. Under Section AM.20 Functions, 

delete Chapter AMW, Office of 

Executive Program Information (OEPI), 

in its entirety. 

Dated: November 13, 2013. 

E.J. Holland, Jr., 

Assistant Secretary for Administration. 

[FR Doc. 2014–01712 Filed 1–28–14; 8:45 am] 

BILLING CODE 4150–24–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: ‘‘Pilot 

Test of an Emergency Department 

Discharge Tool.’’ In accordance with the 

Paperwork Reduction Act of 1995, 44 

U.S.C. 3506(c)(2)(A), AHRQ invites the 

public to comment on this proposed 

information collection. 

This proposed information collection 

was previously published in the Federal 

Register on August 27th, 2013 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 February 28, 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 

Pilot Test of an Emergency Department 

Discharge Tool 

The research study ‘‘Pilot Test of an 

Emergency Discharge Tool’’ fully 

supports AHRQ’s mission. The ultimate 

aim of this study is to pilot test a 

discharge tool which has the potential 

to reduce unnecessary visits to the 

Emergency Department (ED), reduce 

healthcare expenditure in the ED, as 

well as streamline and enhance the 

quality of care delivered to ED patients. 

The ED is an important and frequently 

used setting of care for a large part of the 

U.S. population. In 2006, there were 

nearly 120 million ED visits in the U.S., 

of which only 15.5 million (14.7%) 

resulted in admission to the hospital or 

transfer to another hospital. Thus the 

majority ED visits result in discharge to 

home. Patients discharged from the ED 

face significant risk for adverse 

outcomes, with between 3–5 patients 

per 100,000 visits experiencing an 

unexpected death following discharge 

from the ED. Additionally, a sizable 

minority of patients return to the ED 

frequently. Published studies estimate 

that 4.5% to 8% of patients revisit the 

ED 4 or more times per year, accounting 

for 21% to 28% of all ED visits. Internal 

data from John Hopkins Hospital, 

AHRQ’s contractor for this pilot test, 

supports these findings with 7% of their 

patients accounting for 26% of visits to 

the Johns Hopkins Hospital ED in 2011. 

Patients who revisit the ED contribute 

to overcrowding, unnecessary delays in 

care, dissatisfaction, and avoidable 

patient harm. ED revisits are also an 

important contributor to rising health 

care costs, as ED care is estimated to 

cost two to five times as much as the 

same treatment delivered by a primary 

care physician. Thus it is estimated that 

eliminating revisits and inappropriate 

use of EDs could reduce health care 

spending as much as $32 billion each 

year. Overall, an effective and efficient 

ED discharge process would improve 

the quality of patient care in the ED as 

well as reduce healthcare costs. 

To respond to the challenges faced by 

our nation’s EDs and the patients they 

serve, AHRQ will develop and pilot test 

a tool to improve the ED discharge 

process. More specifically, this project 

has the following goals: 

(1) Develop and Pilot Test a Prototype 

ED Discharge Tool in a limited number 

of settings to assess: 

(a) The feasibility for use with 

patients; 

(b) The methodological and resource 

requirements associated with tool use; 

(c) The feasibility of measuring 

outcomes; 

(d) The costs of implementation and; 

(e) Preliminary outcomes or impacts 

of tool use. 

(2) Revise the Tool based on the 

results from the Pilot Test. 

This study is being conducted by 

AHRQ through its contractor, John 

Hopkins Hospital, 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 


tkelley on DSK3SPTVN1PROD with NOTICES
Federal Register / Vol. 79, No. 19 / Wednesday, January 29, 2014 / Notices 4719 

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 these goals the following 

data collections will be implemented: 

(1) Pilot Test of the Emergency 

Department Discharge Tool (EDT)—The 

EDT will be pilot tested in the three 

John Hopkins EDs in Baltimore. The 

purpose of the EDT is to assist hospitals 

in identifying patients who excessively 

use the ED and can be categorized as 

‘‘frequent ED users,’’ as well as to target 

interventions to these patients to reduce 

the risk of further avoidable revisits. A 

research assistant will screen the 

medical record of all adult patients for 

the presence of frequent ED use, the key 

risk factor for ED discharge failure. 

Frequent ED use is defined as: (1) 1 or 

more previous ED visit within the last 

72-hours, or (2) 3 or more previous ED 

visits within the last 3 months, or (3) 4 

or more ED visits within the last 12 

months. This definition can be modified 

to align with the resources of the 

individual ED. 

This tool uses data collected from the 

record of patients that are flagged as 

frequent ED users. By asking patients a 

series of questions about their medical 

history, the tool also helps to identify 

individuals with risk factors that have 

been shown in the literature to predict 

sub-optimal ED discharges and resulting 

revisits. These risk factors include being 

uninsured, lack of a primary care 

physician, having psychiatric diseases, 

abusing substances, difficulty caring for 

oneself, or having trouble 

comprehending ED discharge 

instructions. 

A User’s Guide (EDT User’s Guide) is 

also provided to assist EDs in 

developing resources to provide 

interventions recommended by the EDT. 

No data collection activities will occur 

from this manual. 

(2) One Month Patient Follow-up 

Telephone Interview—After the ED 

visit, a project research assistant (RA) 

will have a follow-up telephone 

interview with all enrolled patients. 

During the interview, the RA will 

inquire about the success of the 

interventions that were given for the 

patient. 

(3) Three Month Patient Follow-up 

Telephone Interview—Patients who are 

uninsured will receive an additional 

phone call 3 months after the ED visit 

to assess whether or not they were able 

to acquire insurance. 

(4) Implementer Focus Groups— 

AHRQ will conduct four sets of focus 

groups to collect qualitative data about 

the usability and usefulness of the EDT 

from four stakeholder groups: Three 

groups of EDT implementers and one 

group of research assistants. Questions 

for each of the focus groups will vary 

based on their differing objectives: 

(a) EDT Implementers Focus Group 

(non-RA)—For non-RA implementers of 

the EDT (RNs, case managers, social 

workers,), the objectives will include 

exploring: (1) How well it does or does 

not meet implementer goals of 

discharge; (2) experiences with rollout 

and implementation, including 

resources required for implementation; 

(3) impressions of the value, strengths 

and weaknesses of the EDT; and (4) 

unintended consequences or impacts on 

other ED operations. The focus groups 

will consist of 8 implementers. Three 

focus groups will be conducted, one for 

each pilot site. 

(b) Research Assistant Focus Group— 

The three research assistants who will 

be implementing the EDT will 

participate in one focus group in which 

they discuss: (1) Experiences with 

implementation (including comparisons 

in their experiences across the three test 

sites; (2) possible areas for 

improvement; (3) unintended 

consequences or impacts on other ED 

operations. 

(5) Key Informant Interviews—AHRQ 

will conduct semi-structured interviews 

with no more than twenty-four 

individuals that can be classified as 

either ED Directors, patients, or 

community care providers. These 

individuals will provide feedback on 

issues surfaced during the focus groups. 

This will provide an opportunity to 

delve more deeply into specific topics of 

interest. The interview guides are 

included as for patients, for community 

care providers, and for ED Directors. 

(a) Patient Interviews—For the 

patients, the objective will be to explore: 

(1) The barriers they face in obtaining 

health care; (2) their experiences in the 

ED in visits prior to, and after, 

implementation of the EDT (3) their 

satisfaction with the care they received 

in the ED and their remaining unmet 

needs. Fifteen patients will be 

interviewed individually. 

(b) Community Care Providers 

Interviews—For the post-ED care 

providers, the objectives are to explore 

challenges in communication and 

coordination for patients referred to 

them by the ED and the degree to which 

the EDT can address those challenges. 

Post-ED care provider focus group 

members will be drawn from Johns 

Hopkins Community Physicians, EastBaltimore Medical Center (a primary 

referral site for patients without primary 

care), and Healthcare for the Homeless, 

a not-for-profit organization in 

Baltimore, Maryland that provides 

health services, education and advocacy 

to people affected by homelessness. Six 

community care providers will be 

interviewed for this section. 

(c) ED Directors Interviews— 

Interviews from ED Directors will occur 

to get their opinions of the EDT from 

their perspectives as the ultimate 

orchestrators of processes in the 

emergency room and decision-makers 

regarding operations (resources use, 

staffing). Three ED directors will be 

interviewed separately for this portion. 

(6) Administrative and Observational 

Data—Quantitative outcome measures 

will come from an extraction of medical 

record data and direct observations 

performed by project RAs. Data will be 

extracted from hospital billing records 

and Electronic Medical Records (EMRs) 

and will include frequency of revisits, 

cost of 72-hour returns, cost of ED visits 

per 3 months, and the cost of 

implementing the EDT. To calculate 

costs of program implementation, RAs 

will observe the time required by social 

work, case management, and nursing 

staff to implement the interventions 

prescribed in the tool. They will also 

keep a log of the materials given to the 

patients as part of the intervention. To 

evaluate the percentage of patients 

evaluated for assistance or placement, 

RAs will observe case managers/social 

workers during their interaction with 

the patients. To evaluate the percentage 

of follow-up phone calls, the RAs will 

keep a log of attempts and actual 

contacts. Since these data collections 

involve RA observations, or extractions 

from existing medical records, they pose 

no burden to the hospital or public and 

therefore are not included in the burden 

estimates in Exhibits 1 and 2 below. 

No pre-intervention measures will be 

collected because this is a feasibility 

study to evaluate the methodology and 

feasibility of collection of this data. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden for the respondents’ 

time to participate in this pilot test. A 

research assistant will use the EMR to 

screen patients for past frequent ED use. 

This step does not represent a 

participant burden. Based upon 

historical data at our three participating 

sites, we expect approximately 200 

patients per week to qualify as ‘‘frequent 

users’’ at these sites. Based upon 

available resources and recruitment, we 

expect to enroll and use the EDT with 

approximately 50 of these patients per 

week at each site to identify their 

specific risk factors and tailor 


tkelley on DSK3SPTVN1PROD with NOTICES
4720 Federal Register / Vol. 79, No. 19 / Wednesday, January 29, 2014 / Notices 

interventions to their needs. Thus we 

will have a total of 900 patient 

participants (50 patients/per week * 6 

weeks * 3 sites = 900 patients total). It 

will take about 20 minutes per patient 

to collect the data associated with the 

EDT. The one-month patient follow-up 

will be conducted with all 900 patients 

and will take 10 minutes to complete. 

The 3-month patient follow-up will be 

conducted with those patients identified 

as being uninsured and is estimated to 

take 5 minutes to complete. 

Four focus groups will take place 

among RAs and non-RA EDT 

implementers. The first focus group will 

consist of three RAs who implemented 

the discharge tool. The other three 

separate focus groups will exclude RAs 

and include eight other ED personnel 

that implemented the discharge tool. 

The total annualized burden for these 

focus groups is estimated to be 54 hours. 

As a follow-up to the focus groups, indepth interviews will also be conducted 

with members from different 

stakeholder groups. Between 12 and 16 

patients will be interviewed as well as 

three ED directors and six community 

healthcare providers. The interviews 

will be conducted in person and require 

one hour to complete. The total 

annualized burden for these interviews 

is estimated to be 30 hours. 

Exhibit 2 shows the annualized cost 

burden associated with the respondents’ 

time to participate in the pilot test. The 

total annualized cost burden is 

estimated to be $13,262. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Pilot Test of the Emergency Department Discharge Tool (EDT) 

EDT .................................................................................................................. 900 1 20/60 300 

One Month Patient Follow-up .......................................................................... 900 1 10/60 150 

Three Month Patient Follow-up ....................................................................... 180 1 5/60 15 

Implementer Focus Groups 

RA Focus Group .............................................................................................. 3 1 2 6 

EDT Implementer (non-RA) #1 Focus Group .................................................. 8 1 2 16 

EDT Implementer (non-RA) #2 Focus Group .................................................. 8 1 2 16 

EDT Implementer (non-RA) #3 Focus Group .................................................. 8 1 2 16 

Key Informant Interviews 

Community Healthcare Provider Interview ...................................................... 6 1 2 12 

Patient Interview .............................................................................................. 15 1 1 15 

ED Director Interview ....................................................................................... 3 1 1 3 

Total .......................................................................................................... 2,031 NA NA 549 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Form name Number of 

respondents 

Total 

burden hours 

Average 

hourly wage 

rate* 

Total 

cost burden 

Pilot Test of the Emergency Department Discharge Tool (EDT) 

EDT .................................................................................................................. 900 300 a $22.01 $6,603 

One Month Patient Follow-up .......................................................................... 900 150 a 22.01 3,302 

Three Month Patient Follow-up ....................................................................... 180 15 a 22.01 330 

Implementer Focus Groups 

RA Focus Group .............................................................................................. 3 6 d 17.86 107 

EDT Implementer (non-RA) #1 Focus Group .................................................. 8 16 b 27.42 439 

EDT Implementer (non-RA) #2 Focus Group .................................................. 8 16 b 27.4 439 

EDT Implementer (non-RA) #3 Focus Group .................................................. 8 16 b 27.42 439 

Key Informant Interviews 

Community Healthcare Provider Focus Group ................................................ 6 12 c 45.36 544 

Patient Interview .............................................................................................. 15 15 a 22.01 330 

ED Director Interview ....................................................................................... 3 3 e 97.30 292 

Total .......................................................................................................... 2,031 549 NA 12,825 

* National Compensation Survey: Occupational wages in the United States May 2012, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’ a based on the mean wages for All Occupations (00–0000). 

b salary based upon average of: 2 nurses (29–1141), 2 case managers (29–1141), 2 social workers (21–1022), and 2 research assistants (19– 

4061). c salary based upon average of: 2 physicians (29–1060), 2 nurses (29–1141), 2 case managers (29–1141), 2 social workers (21–1022). d based on mean hourly wage of: Social Science Research Assistants (19–4061). 

e based on mean annual wage of: Physicians and Surgeons (29–1060). 


tkelley on DSK3SPTVN1PROD with NOTICES
Federal Register / Vol. 79, No. 19 / Wednesday, January 29, 2014 / Notices 4721 

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 health care research, quality 

improvement and 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: January 16, 2014. 

Richard Kronick, 

AHRQ Director. 

[FR Doc. 2014–01709 Filed 1–28–14; 8:45 am] 

BILLING CODE 4160–90–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: 

‘‘SelectMD 2.0 Clinician Choice 

Experiment.’’ In accordance with the 

Paperwork Reduction Act of 1995, 44 

U.S.C. 3506(c)(2)(A), AHRQ invites the 

public to comment on this proposed 

information collection. 

DATES: Comments on this notice must be 

received by March 31, 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 

SelectMD 2.0 Clinician Choice 

Experiment 

This study builds on previous 

research conducted as part of the 

Consumer Assessment of Healthcare 

Providers and Systems (CAHPS) 

program to explore new ways of 

integrating patient comments with other 

performance metrics in web-based 

quality reports for consumers to support 

their choice of physicians. Our previous 

consumer choice study, referred to as 

SelectMD 1.0 (approved by OMB on 3/ 

8/10 under OMB Control Number 0935– 

0161), revealed important risks and 

opportunities of using patient comments 

that require additional research in order 

to develop effective guidance for report 

sponsors. Sponsors of performance 

reports in both the public and private 

sectors, including Federal agencies such 

as the Centers for Medicare & Medicaid 

Services (CMS), have indicated strong 

interest in receiving such guidance on 

strategies for effectively incorporating 

patient comments to increase 

consumers’ use of public reports and to 

enhance their ability to interpret CAHPS 

and other performance measures. 

This follow-on study (referred to as 

SelectMD 2.0) will use an experimental 

design to test different methods of 

incorporating patient comments along 

with CAHPS survey results, the 

Healthcare Effectiveness Data and 

Information Set (HEDIS)-like measures 

of effective clinical treatments, and 

indicators of patient safety in web-based 

physician quality reports. The study 

will help AHRQ understand how people 

choose a doctor as their regular source 

of medical care and advice. 

The study has three stages. In the first 

stage, respondents will be asked some 

questions about their health care 

experiences and how they go about 

choosing a doctor. In the second stage 

the respondents will log onto an 

experimental Web site that has 

information about a fictitious set of 

doctors from which to choose. 

Respondents will be asked to use the 

information on the Web site to select a 

doctor who they think would be the best 

for their health care needs. Although 

they will not really be selecting a 

doctor, they will be asked to consider 

the choice as carefully as if they were 

making it for themselves. In the third 

stage, following their selection of a 

doctor, respondents will answer a set of 

questions about how they made their 

choice of doctor, how useful they found 

the Web site, and how confident they 

were in the choice they made. 

This research has the following goals: 

(1) To expand on the findings from 

AHRQ’s previous choice experiment 

regarding how including narrative 

patient comments in web-based 

physician quality reports influences the 

ways in which consumers learn about 

and select among clinicians, and 

(2) to assess whether and how patient 

comments can be presented in a way 

that promotes learning about physician 

quality and complements rather than 

detracts from standardized measures of 

quality. 

This study is being conducted by 

AHRQ through its contractors, RAND 

and Yale 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 data collections will be 

implemented over the three stages of the 

experiment: 

(1) Pre-Choice Survey—The purpose 

of this survey is to measure the 

respondents’ previous exposure to 

information on health care provider 

performance and how they go about 

choosing a physician. 

(2) Experimental Web site—The 

purpose of this site is to present 

different combinations and displays of 

performance information that 

respondents will use to select a doctor. 

Respondents will be randomly assigned 

to one of eight different versions of the 

experimental SelectMD Web site that 

will vary according to the level of detail 

presented, how patient comments are 

grouped and labeled, whether 

respondents can choose which and how 

much information to review, and 

whether respondents have access to live 

telephone assistance when making their 

choices. 

(3) Post-Choice Survey—The purpose 

of the post-choice survey is to assess 

how respondents made their doctor 

selection, how useful the Web site 

version assigned to them was in helping 


tkelley on DSK3SPTVN1PROD with NOTICES