Federal Register / Vol. 77, No. 194 / Friday, October 5, 2012 / Notices 60997 

Commissioned Corps Support Services 

to the Office of the Surgeon General 

(ACM). The changes are as follows: 

I. Under Part A, Chapter AC, Office of 

the Assistant Secretary for Health, make 

the following changes: 

A. Under Section AC.20, Functions, 

‘‘I. Office of Surgeon General (ACM), 

Section ACM.20 Functions, (c) Division 

of Commissioned Corps Personnel and 

Readiness (ACM2), 3. Assignments & 

Career Management Branch (ACM23)’’ 

add the following functions, beginning 

with (13) through (22): 

3. Assignments and Career 

Management Branch (ACM23). (13) 

Administers a payroll system for active 

duty Commissioned Corps officers of 

basic pay, allowances, and special or 

incentive pay in coordination with the 

Departments of Defense, Veterans 

Affairs, and Treasury; (14) Administers 

a pay system for retired Commissioned 

Corps officers and survivor annuitants 

in coordination with the Departments of 

Veterans Affairs and Treasury; (15) 

Administrative management of active 

duty Commissioned Corps officer 

healthcare and support for healthcare 

authorization and access to care; (16) 

Provides pre-retirement counseling, 

conducts retirement boards, determines 

eligibility for retirement, processes 

retirements, and recalls retirees to active 

duty; (17) Administration of periodic, 

separation and retirement health 

evaluations; (18) Review and award of 

Combat-Related Special Pay, 

Servicemembers’ Group Life Insurance 

Traumatic Injury Protection Program, 

and Line of Duty determinations; (19) 

Management and support of ongoing 

medical and behavioral health 

challenges among active duty officers; 

(20) Management of fitness for duty and 

disability evaluations and 

determinations; (21) Administration of 

medical waiver evaluations and 

issuances; and (22) Management of 

Medical Evaluation and Appeal Boards. 

B. Under Section AC.20, Functions, 

‘‘I. Office of Surgeon General (ACM), 

Section ACM.20 Functions, (e) Division 

of Systems Integration (ACM6), add the 

following functions, beginning with (4) 

through (9): 

(e) Division of Systems Integration 

(ACM6). (4) Certifies monthly 

Commissioned Corps payroll to 

Treasury; (5) Administers supplemental 

and third-party payments to Treasury; 

(6) Reviews payroll reports, identifies 

potential payroll-related issues, and 

validates the monthly Commissioned 

Corps payroll; (7) Provides data 

reporting and data extracts to HHS and 

other governmental organizations and 

agencies; (8) Maintains Commissioned 

Corps personnel data systems and 

ensures integrity and availability of 

personnel and operational data; and (9) 

Maintains Commissioned Corps Web 

sites and ensures 508 compliance. 

II. Continuation of Policy: Except as 

inconsistent with this reorganization, all 

statements of policy and interpretations 

with respect to the Commissioned Corps 

of the PHS heretofore issued and in 

effect prior to this reorganization are 

continued in full force and effect. 

III. Delegations of Authority. 

Directives and orders of the Secretary, 

Assistant Secretary for Health, or 

Surgeon General and all delegations and 

re-delegations of authority previously 

made to officials and employees of the 

affected organizational components will 

continue in them or their successors 

pending further re-delegation, provided 

they are consistent with this 

reorganization. All delegated authorities 

associated with or necessary to 

administer, operate, and manage 

transferred entities affected by this 

reorganization are transferred to the 

Assistant Secretary for Health and may 

be re-delegated. 

IV. Funds, Personnel, and Equipment. 

Transfer of organizations and functions 

affected by this reorganization shall be 

accompanied by direct and support 

funds, positions, personnel, records, 

equipment, supplies, and other 

resources. 

Dated: September 21, 2012. 

E.J. Holland, Jr., 

Assistant Secretary for Administration. 

[FR Doc. 2012–24564 Filed 10–4–12; 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: 

‘‘Development of a Health Information 

Rating System (HIRS).’’ 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 December 4, 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.lefkowitz@AHRQ.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

Development of a Health Information 

Rating System (HIRS) 

Over the past several years, low 

health literacy has been identified as an 

important health care quality issue. 

Healthy People 2010 defined health 

literacy as ‘‘the degree to which 

individuals have the capacity to obtain, 

process, and understand basic health 

information and services needed to 

make appropriate health decisions.’’ In 

2003, the Institute of Medicine 

identified health literacy as a crosscutting area for health care quality 

improvement. According to the 2003 

National Assessment of Adult Literacy, 

only 12 percent of adults have proficient 

health literacy. 

Persons with limited health literacy 

face numerous health care challenges. 

They often have a poor understanding of 

basic medical vocabulary and health 

care concepts. A study of patients in a 

large public hospital showed that 26 

percent did not understand when their 

next appointment was scheduled and 42 

percent did not understand instructions 

to ‘‘take medication on an empty 

stomach.’’ In addition, limited health 

literacy leads to more medication errors, 

more and longer hospital stays, and a 

generally higher level of illness, 

resulting in an estimated excess cost for 

the US health care system of $50 billion 

to $73 billion per year. 

Health care providers can improve 

their patients’ health outcomes by 

delivering the right information at the 

right time in the right way to help 

patients prevent or manage chronic 

conditions such as diabetes, 

cardiovascular disease, hypertension, 

and asthma. Electronic health records 

(EHRs) can help providers offer patients 

the right information at the right time 

during office visits, by directly 

connecting patients to helpful resources 

on treatment and self-management. 

EHRs can also facilitate clinicians’ use 

of patient health education materials in 

the clinical encounter. However, health 

education materials delivered by EHRs, 


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60998 Federal Register / Vol. 77, No. 194 / Friday, October 5, 2012 / Notices 

when available, are rarely written in a 

way that is understandable and 

actionable for patients with basic or 

below basic health literacy—an 

estimated 77 million people in the 

United States. 

In order to fulfill the promise of EHRs 

for all patients, especially for persons 

with limited health literacy, clinicians 

should have a method to determine how 

easy a health education material is for 

patients to understand and act on, have 

access to a library of easy-to-understand 

and actionable materials, understand 

the relevant capabilities and features of 

EHRs to provide effective patient 

education, and be made aware of these 

resources and information. Therefore, 

AHRQ developed a project that includes 

the following four major tasks: (1) 

Develop a valid and reliable Health 

Information Rating System (HIRS), (2) 

create a library of patient health 

education materials, (3) review EHR’s 

patient education capabilities and 

features, and (4) educate EHR vendors 

and users. This project relates to the 

first task only. 

As a first step, AHRQ has developed 

a draft HIRS using the following 

rigorous multistage approach that draws 

upon existing rating systems, the 

evidence base in the literature, and the 

real-world expertise and experience of a 

Technical Expert Panel (TEP): 

(1) Gather and synthesize evidence on 

existing rating systems and literature on 

consumers’ understanding of health 

information. Seek TEP review of the 

summary of existing health information 

rating systems. Develop item pool for 

each domain—understandability and 

actionability, defined as follows: 

• Health education materials are 

understandable when consumers of 

diverse backgrounds and varying 

degrees of health literacy can process 

and explain key messages. 

• Health education materials are 

actionable when consumers of diverse 

backgrounds and varying levels of 

health literacy can identify what they 

can do based on the information 

presented. 

(2) Assess the face and content 

validity of the domains (i.e., 

understandability and actionability) 

with the TEP. 

(3) Assess the inter-rater reliability of 

the HIRS on English-language health 

education materials. Seek TEP review of 

results and provide guidance on how to 

address discrepancies. 

The draft HIRS was used by AHRQ 

researchers to rate 2 sets of patient 

health education materials: A set of 6 

education materials related to asthma 

and a set of 6 education materials 

related to colonoscopy. Each of these 12 

health education materials received a 

score for their understandability and 

actionability. Some of the materials 

received good scores on the draft HIRS, 

meaning that the researchers considered 

them to be understandable or 

actionable, and some materials received 

poor scores on the draft HIRS, 

indicating that the materials had low 

understandability or low actionability. 

The final stage of developing a 

reliable and valid rating system to assess 

the understandability and actionability 

of health education materials is testing 

with consumers. 

This project has the following goals: 

(1) To assess the construct validity of 

AHRQ’s draft HIRS. The 12 rated health 

education materials will be tested with 

a total of 48 English-speaking 

consumers. Consumers will review 

materials and be asked questions to test 

whether they understand the materials 

and whether they know what actions to 

take. The outcome of this testing will be 

an HIRS that will offer professionals 

(e.g., clinicians, health librarians, etc.) a 

systematic method to evaluate and 

compare the understandability and 

actionability of health education 

materials. Since actionability is a new 

domain, we are testing it distinct from 

understandability though there is a 

theoretical relationship between the 

domains as we have defined them; that 

is, a material cannot be actionable if it 

is not first understandable. So 

actionability may in fact be a subdomain of understandability. Besides 

assessing the construct validity, 

consumer testing will help us determine 

how to revise and improve the HIRS. 

(2) Finalize the HIRS and instructions 

for users, and make them publicly 

available on AHRQ’s Web site. 

This study is being conducted by 

AHRQ through its contractor, Abt 

Associates, 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 

To achieve the goals of the project the 

following data collections and activities 

will be implemented: 

(1) Demographic Questionnaire—The 

demographic questionnaire will collect 

basic demographic information about 

each participant. This data will allow 

the analysis to detect differences in 

health literacy by population subgroups. 

(2) Short Test of Functional Health 

Literacy in Adults (S–TOFHLA) 

Questionnaire—The S–TOFHLA will be 

administered once to all participants to 

assess their level of health literacy. 

(3) Health Education Materials & 

Questionnaire—Asthma/Inhaler—This 

includes a set of educational materials 

related to asthma and proper use of 

inhalers. Each consumer will be 

randomly assigned one of the six 

following materials: 

(i) An audiovisual material 

(understandable and actionable), titled 

How to use an inhaler by the Utah 

Department Health Asthma Program. 

(ii) An audiovisual material 

(understandable and poorly actionable), 

titled Asthma Triggers by Children’s 

Healthcare of Atlanta. 

(iii) An audiovisual material (poorly 

understandable), titled Asthma Inhaler 

Medication Technique—How to Take an 

Asthma Inhaler by America’s Allergist. 

(iv) A printable material 

(understandable and actionable), titled 

Asthma: How to Use A Metered Dose 

Inhaler, by FamilyDoctor.org. 

(v) A printable material 

(understandable and poorly actionable), 

titled How to use an inhaler—no spacer, 

by MedlinePlus. 

(vi) A printable material (poorly 

understandable), titled Inhaled Asthma 

Medications: Tips to Remember, by the 

American Academy of Allergy Asthma 

& Immunology. 

After seeing the randomly assigned 

audiovisual or printable material the 

participants will be administered a brief 

questionnaire to assess their 

understanding of how to use an inhaler 

and what actions to take based on the 

material. 

(4) Health Education Materials & 

Questionnaire—Colonoscopy—This 

includes a set of educational materials 

related to colonoscopy. Each consumer 

will be randomly assigned one of the six 

following materials: 

(i) An audiovisual material 

(understandable and actionable), titled 

Colonoscopy Patient Education Video 

by Krames. 

(ii) An audiovisual material 

(understandable and poorly actionable), 

titled Colorectal Cancer Awareness by 

St. Vincent’s Healthcare. 

(iii) An audiovisual material (poorly 

understandable), titled Prepare for a 

Colonoscopy by The University of Texas 

MD Anderson Cancer Center. 

(iv) A printable material 

(understandable and actionable), titled 

Getting Ready for Your Colonoscopy by 

West Chester Endoscopy Suite. 

(v) A printable material 

(understandable and poorly actionable), 

titled Colonoscopy in the National 


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Federal Register / Vol. 77, No. 194 / Friday, October 5, 2012 / Notices 60999 

Digestive Diseases Information 

Clearinghouse (NDDIC). 

(vi) A printable material (poorly 

understandable), titled Colonoscopy by 

the American College of Surgeons 

Division of Education. 

After viewing the randomly assigned 

audiovisual or printable material the 

participants will be administered a brief 

questionnaire to assess their 

understanding of a colonoscopy and 

what actions to take based on the 

material. 

The data collected from this project 

will be used to assess the construct 

validity of and inform revisions to the 

HIRS. The HIRS will be the first 

instrument that can assess the 

understandability and actionability of 

patient health education materials that 

can be incorporated into an EHR, 

including printable and audiovisual 

materials. Note that the materials to be 

assessed need not currently be 

incorporated into EHRs; for now, we are 

focusing on materials that have the 

potential to be incorporated into EHRs. 

No claim is made that the results from 

this study will be generalizable in the 

statistical sense. Rather, the consumer 

testing will be informative and critical 

to ensuring we have developed a valid 

rating system by conducting consumer 

testing. 

Estimated Annual Respondent Burden 

Exhibit 1 presents estimates of the 

annualized burden hours for the 

participants’ time to participate in this 

research. The Demographic and S– 

TOFHLA questionnaires will be 

completed by all 48 participants and 

takes 5 and 7 minutes, respectively, to 

complete. Each of the 48 participants 

will review 2 different health education 

materials and then answer the 

associated questionnaires for each 

material topic. Participants will review 

English-language materials related to 

inhaler use and colonoscopy. To review 

each material and answer the associated 

questionnaire requires 30 minutes (15 

minutes to review the materials and 15 

minutes to complete the questionnaire). 

The total annualized burden is 

estimated to be 58 hours. 

Exhibit 2 presents the estimated 

annualized cost burden associated with 

the respondents’ time to participate in 

this research. The total cost burden is 

estimated at $1,237. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Data collection Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Demographic Questionnaire ............................................................................ 48 1 5/60 4 

S–TOFHLA Questionnaire ............................................................................... 48 1 7/60 6 

Health Education Materials & Questionnaire—Inhaler .................................... 48 1 30/60 24 

Health Education Materials & Questionnaire—Colonoscopy .......................... 48 1 30/60 24 

Total .......................................................................................................... 192 na na 58 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Data collection Number of 

respondents 

Total burden 

hours 

Average 

hourly wage 

rate* 

Total cost 

burden 

Demographic Questionnaire ............................................................................ 48 4 $21.35 $85 

S–TOFHLA Questionnaire ............................................................................... 48 6 21.35 128 

Health Education Materials & Questionnaire—Inhaler .................................... 48 24 21.35 512 

Health Education Materials & Questionnaire—Colonoscopy .......................... 48 24 21.35 512 

Total .......................................................................................................... 192 58 na 1,237 

* Based upon the mean wage for all occupations, National Compensation Survey: Occupational wages in the United States May 2010, ‘‘U.S. 

Department of Labor, Bureau of Labor Statistics.’’ 

Estimated Annual Costs to the Federal 

Government 

The total cost of this contract to the 

government is $524,945, and the project 

extends over 3 years (July 19, 2010 to 

July 18, 2013). The data collection for 

which we are seeking OMB clearance 

will take place from February 1, 2013 to 

March 31, 2013. Exhibit 3 shows a 

breakdown of the total cost as well as 

the annualized cost for the data 

collection, processing and analysis 

activity for this entire contract. 

EXHIBIT 3—ESTIMATED COST

Cost component Total cost Annual cost 

Project Development ............................................................................................................................................... $66,447 $22,149 

Data Collection Activities ......................................................................................................................................... 129,547 43,182 

Data Processing and Analysis ................................................................................................................................. 129,548 43,183 

Publication of Results .............................................................................................................................................. 131,571 43,857 

Project Management ................................................................................................................................................ 67,832 22,611 

Total .................................................................................................................................................................. 524,945 174,982 


pmangrum on DSK3VPTVN1PROD with NOTICES
61000 Federal Register / Vol. 77, No. 194 / Friday, October 5, 2012 / Notices 

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: September 27, 2012. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2012–24454 Filed 10–4–12; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Meeting of the National Advisory 

Council for Healthcare Research and 

Quality 

AGENCY: Agency for Healthcare Research 

and Quality (AHRQ), HHS. 

ACTION: Notice of public meeting. 

SUMMARY: In accordance with section 

10(a) of the Federal Advisory Committee 

Act, 5 U.S.C. App. 2, this notice 

announces a meeting of the National 

Advisory Council for Healthcare 

Research and Quality. 

DATES: The meeting will be held on 

Friday, November 9, 2012, from 8:30 

a.m. to 3:30 p.m. 

ADDRESSES: The meeting will be held at 

the Eisenberg Conference Center, 

Agency for Healthcare Research and 

Quality, 540 Gaither Road, Rockville, 

Maryland 20850. 

FOR FURTHER INFORMATION CONTACT: 

Jaime Zimmerman, Coordinator of the 

Advisory Council, at the Agency for 

Healthcare Research and Quality, 540 

Gaither Road, Rockville, Maryland 

20850, (301) 427–1456. For press-related 

information, please contact Alison Hunt 

at (301) 427–1244. 

If sign language interpretation or other 

reasonable accommodation for a 

disability is needed, please contact the 

Food and Drug Administration (FDA) 

Office of Equal Employment 

Opportunity and Diversity Management 

on (301) 827–4840, no later than Friday, 

October 26, 2012. The agenda, roster, 

and minutes are available from Ms. 

Bonnie Campbell, Committee 

Management Officer, Agency for 

Healthcare Research and Quality, 540 

Gaither Road, Rockville, Maryland 

20850. Ms. Campbell’s phone number is 

(301) 427–1554. 

SUPPLEMENTARY INFORMATION: 

I. Purpose 

The National Advisory Council for 

Healthcare Research and Quality is 

authorized by Section 941 of the Public 

Health Service Act, 42 U.S.C. 299c. In 

accordance with its statutory mandate, 

the Council is to advise the Secretary of 

the Department of Health and Human 

Services and the Director, Agency for 

Healthcare Research and Quality 

(AHRQ), on matters related to AHRQ’s 

conduct of its mission including 

providing guidance on (A) priorities for 

health care research, (B) the field of 

health care research including training 

needs and information dissemination on 

health care quality and (C) the role of 

the Agency in light of private sector 

activity and opportunities for public 

private partnerships. 

The Council is composed of members 

of the public, appointed by the 

Secretary, and Federal ex-officio 

members specified in the authorizing 

legislation. 

II. Agenda 

On Friday, November 9, 2012, there 

will be a subcommittee meeting for the 

National Healthcare Quality and 

Disparities Report scheduled to begin at 

7:30 a.m. The Council meeting will 

convene at 8:30 a.m., with the call to 

order by the Council Chair and approval 

of previous Council summary notes. The 

meeting will begin with a report from 

the National Advisory Council 

Subcommittee on the Children’s Health 

Insurance Program Reauthorization Act. 

The AHRQ Director will then present 

her update on current research, 

programs, and initiatives. Following the 

morning session, the Council will hold 

an Executive Session between the hours 

of 12:00 p.m. and 1:30 p.m. to discuss 

strategic issues related to the Agency for 

Healthcare Research and Quality. This 

Executive Session will be closed to the 

public in accordance with 5 U.S.C. App. 

2, section 10(d) and 5 U.S.C. 

552b(c)(9)(B). This portion of the 

meeting is likely to disclose information 

the premature disclosure of which 

would be likely to significantly frustrate 

implementation of a proposed agency 

action to the public. The final agenda 

will be available on the AHRQ Web site 

at www.AHRQ.gov no later than Friday, 

November 2, 2012. 

Dated: September 27, 2012. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2012–24455 Filed 10–4–12; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

Advisory Committee to the Director 

(ACD), Centers for Disease Control and 

Prevention—Health Disparities 

Subcommittee (HDS) 

In accordance with section 10(a) (2) of 

the Federal Advisory Committee Act 

(Pub. L. 92–463), the Centers for Disease 

Control and Prevention (CDC) 

announces the following meeting of the 

aforementioned subcommittee: 

Time and Date: 10 a.m.–12:15 p.m. 

EDT, October 24, 2012. 

Place: Teleconference. 

Status: Open to the public, limited 

only by the availability of telephone 

ports. The public is welcome to 

participate during the public comment 

period. A public comment period is 

tentatively scheduled for 12 p.m. to 

12:15 p.m. To participate in the 

teleconference, please dial (866) 561– 

5277 and enter code 2238494. 

Purpose: The Subcommittee will 

provide advice to the CDC Director 

through the ACD on strategic and other 

health disparities and health equity 

issues and provide guidance on 

opportunities for CDC. 

Matters to be discussed: Agenda items 

will include the following: Office of 

Minority Health and Health Equity 

updates; discussion of draft 

recommendations from April 2012 

meeting with the IOM Health Disparities 

Roundtable; discussion of Critical issues 

and Recommendations (Strategies to 

Strengthen CDC Response to Social 

Determinants of Health and Inequities); 

discussion regarding organizing the 

workflow of the HDS going forward; and 

HDS membership after June 2013. 

The agenda is subject to change as 

priorities dictate. 


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