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[Federal Register: March 11, 2010 (Volume 75, Number 47)]
[Notices]               
[Page 11540-11542]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr11mr10-58]                         

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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: ``Development and Evaluation of AIIRQ's Quality Indicators 
Improvement Toolkit.'' In accordance with the Paperwork Reduction Act, 
44 U.S.C. 3501-3520, AHRQ invites the public to comment on this 
proposed information collection.
    This proposed information collection was previously published in 
the Federal Register on December 31st, 2009 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 April 12, 2010.

ADDRESSES: Written comments should be submitted to: AHRQ's OMB Desk 
Officer by fax at (202) 395-6974 (attention: AHRQ's desk officer) or by 
e-mail at OIRA_submission@omb.eop.gov (attention: AHRQ's desk 
officer).
    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 e-mail at 
doris.lefkowitz@AHRQ.hhs.gov.

SUPPLEMENTARY INFORMATION:

Proposed Project

Development and Evaluation of AHRQ's Quality Indicators Improvement 
Toolkit

    An important part of AHRQ's mission is to disseminate information 
and tools that can support improvement in quality and safety in the 
U.S. health care community. See 42 U.S.C. 299(b)(1)(F); 299a(a)(1) and 
(2). This proposed information collection supports that part of AHRQ's 
mission by developing and evaluating a toolkit that will enable 
hospitals to effectively use AHRQ's Quality Indicators (QIs).
    AHRQ has developed sets of QIs that can be used by the Agency and 
others to document quality and safety conditions at U.S. hospitals. Two 
sets of QIs will be used in this proposed toolkit: the Inpatient 
Quality Indicators (IQIs) and the Patient Safety Indicators (PSIs). The 
IQIs contain measures of volume, mortality, and utilization for common 
medical conditions and major surgical procedures. The PSIs are a set of 
measures to screen for potentially preventable adverse events that 
patients may experience during hospitalization. These QIs have been 
previously developed and evaluated by AHRQ, and are in use at a number 
of hospitals throughout the country. The QIs and supportive 
documentation on how to work with them are posted on AHRQ's Web site at 
http://www.qualityindicators.ahrg.gov. Many of the QIs have been 
endorsed by the National Quality Forum through its consensus review 
process.
    Values for each QI can be estimated for a given hospital by 
applying computations in SAS programs developed by AHRQ to the 
hospital's pre-existing inpatient encounter data. To identify potential 
areas for improving the quality and safety of the care that a hospital 
provides, the hospital can use these data to examine its current 
performance on each QI measure, changes in its performance over time, 
and how its performance compares to that of other hospitals. However, 
despite the availability of the QIs as tools to help hospitals assess 
their performance, many U.S. hospitals

[[Page 11541]]

have limited experience with the use of such measurement tools, or in 
using quality improvement methods to improve their performance as 
assessed by these measures.
    An alpha version of the Quality Indicators Improvement Toolkit will 
be developed, which then will be field tested by six hospitals. During 
the field test, the proposed evaluation will assess the usability of 
the Toolkit for hospitals, and it will examine their experiences in 
implementing interventions to improve their performance on the AHRQ 
QIs, as well as effects on trends in the hospitals' AHRQ QI values. 
Using results from the evaluation, the alpha Toolkit will be revised to 
yield a final Toolkit that will be effective in supporting hospitals' 
quality improvement efforts.
    The development and evaluation of the Quality Indicators 
Improvement Toolkit will be conducted by AHRQ's contractor, the RAND 
Corporation, under contract number HHSA290200600017I. RAND has 
subcontracted with the University HealthSystem Consortium (UHC) to 
partner in the development of the Toolkit and field testing of it with 
hospitals as they use the Toolkit in carrying out initiatives designed 
to improve performance on the QIs.

Method of Collection

    Case study research methods will be used for this qualitative 
study. The following four data collection instruments will be used in 
the evaluation:
    (1) Pre/post-test interview protocol--Consisting of both open- and 
closed-ended questions will be administered prior to implementation of 
the Toolkit and again post implementation. The purpose of this data 
collection is to obtain data on the steps the hospitals took to 
implement actions to improve performance on the QIs; their plans for 
making process changes; and their experiences in achieving changes and 
perceptions regarding lessons learned that could be shared with other 
hospitals.
    (2) Update protocol--Consisting of both open- and closed-ended 
questions will be administered three times during the study (quarterly 
during the implementation year). The purpose of this data collection is 
to capture longitudinal data regarding hospitals' progress in 
implementing changes, successes and challenges, and plans for 
subsequent actions. These data will include descriptive information on 
changes over time in the hospitals' implementation actions and how they 
are using the Toolkit, as well as experiential information on the 
perceptions of participants regarding the improvement implementation 
process and its effects. It also ensures the collection of information 
close to pertinent events, which avoids the recall bias associated with 
retrospective reporting of experiences.
    (3) Usability testing protocol--Also consisting of both open and 
closed ended questions will be administered once at the end of the 
evaluation period. The purpose of this data collection is to gather 
information from the hospitals on how they used each tool in the 
Toolkit, the ease of use of each tool, which tools were most helpful, 
suggested changes to improve each tool, and suggestions for other tools 
to add to the Toolkit. This information will be used in the revisions 
of the Toolkit following the end of the field test.
    (4) AHRQ QI data collection tool--Used to collect the IQI and PSI 
measures calculated by the hospitals both prior to implementation of 
the Toolkit and again post implementation. The purpose of this data 
collection is to determine if the hospitals' implementation actions, 
including use of the toolkit, had a measurable impact on the QI 
measures.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
respondents' time to participate in this information collection. Three 
protocols will be used to collect data from respondents in interviews 
that will take one hour each. The pre/post-test interview protocol will 
be administered twice--at the beginning and end of the field-test year. 
The pre- test interviews will be performed as one-hour group interviews 
conducted with the six hospitals' implementation teams at the start of 
the year. At the end of the year, post-test interviews will be 
performed as one-hour group interviews with three of the hospitals and 
during site visits with the other three hospitals. At each site visit, 
data will be collected through one-hour interviews with the hospital's 
implementation team as well as through other group interviews performed 
separately with each of the key stakeholder groups--physicians, nurses, 
clerks, and others. The additional data from the stakeholder groups 
will allow triangulation of variations in perceptions and experiences 
among different groups, of which the implementation teams might not be 
aware.
    The quarterly update protocol will be administered quarterly to 2 
hospital staff members from each hospital during the year (in months 3, 
6, and 9). The usability testing protocol will be administered to 4 
staff members once at the end of the evaluation period. The AHRQ QI 
data collection tool will be used both pre- and post-implementation to 
collect the QI measures. The total burden is estimated to be 360 hours.
    Exhibit 2 shows the estimated annualized cost burden associated 
with the respondents' time to participate in the evaluation. The total 
cost burden is estimated to be $9,886.

                                  Exhibit 1--Estimated Annualized Burden Hours
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                                                                     Number of
                    Form name                        Number of     responses per     Hours per     Total burden
                                                     hospitals       hospital        response          hours
----------------------------------------------------------------------------------------------------------------
Pre/Post-Test Interview Protocol................               6              26               1             156
Quarterly Update Protocol.......................               6               6               1              36
Usability Testing Protocol......................               6               4               1              24
AHRQ QI Data Collection Tool....................               6               2             *12             144
    Total.......................................              24              NA              NA             360
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* Includes time to program and run the computer programs necessary to produce the measures.


[[Page 11542]]


                            Exhibit 2--Estimated Annualized Cost Burden for Hospitals
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                                                     Number of     Total burden   Average hourly    Total cost
                    Form name                        hospitals         hours        wage rate*        burden
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Pre/Post-Interview Protocol.....................               6             156          $27.46          $4,284
Quarterly Update Protocol.......................               6              36           27.46             989
Usability Testing Protocol......................               6              24           27.46             659
AHRQ QI Data Collection Tool....................               6             144           27.46           3,954
    Total.......................................              24             360              NA           9,886
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* Based upon the mean of the average wages, National Compensation Survey: Occupational wages in the United
  States, March 2009, ``U.S. Department of Labor, Bureau of Labor Statistics.'' Used as an overall average wage
  rate across the various types of staff involved in the quality improvements.

Estimated Annual Costs to the Federal Government

    Exhibit 3 shows the estimated total and annualized cost of this 
project to the government. The estimated total cost for the evaluation 
work is $209,827 over the two-year year project, with an annualized 
total cost of $104,914. These costs were developed based on estimates 
of staff days required, to which administrative expenses are applied, 
and based on airfare, hotel, and per diem costs for staff travel for 
the site visits at the end of the evaluation.

               Exhibit 3--Estimated Cost of the Evaluation
------------------------------------------------------------------------
                                                            Annualized
             Cost component                 Total cost         cost
------------------------------------------------------------------------
Protocol Development....................         $40,278         $20,139
Data Collection Activities..............          91,104          45,552
Data Analysis...........................          45,252          22,626
Publication of Results..................          24,370          12,185
Travel for Site Visits..................           8,823           4,412
    Total...............................         209,827         104,914
------------------------------------------------------------------------

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 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 24, 2010.
Carolyn M. Clancy,
Director.
[FR Doc. 2010-4948 Filed 3-10-10; 8:45 am]
BILLING CODE 4160-90-M
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