44172 Federal Register / Vol. 79, No. 146 / Wednesday, July 30, 2014 / Notices 

three (3) years, beginning on July 9, 

2014: 

(1) That the administrative actions 

delineated in (2)–(4) below will be 

required for three (3) years after the 

effective date of the Agreement, 

beginning on the date of Respondent’s 

employment in a research position in 

which he receives or applies for U.S. 

Public Health Service (PHS) support; 

however, if within three (3) years of the 

effective date of the Agreement, 

Respondent has not obtained 

employment in a research position in 

which he receives or applies for PHS 

support, the administrative actions in 

(2)–(4) will no longer apply; 

(2) to have any PHS-supported 

research supervised; Respondent agrees 

that prior to the submission of an 

application for PHS support for a 

research project on which the 

Respondent’s participation is proposed 

and prior to Respondent’s participation 

in any capacity on PHS-supported 

research, Respondent shall ensure that a 

plan for supervision of Respondent’s 

duties is submitted to ORI for approval; 

the supervision plan must be designed 

to ensure the scientific integrity of 

Respondent’s research; Respondent 

agrees that he shall not participate in 

any PHS-supported research until such 

a supervision plan is submitted to and 

approved by ORI; Respondent agrees to 

maintain responsibility for compliance 

with the agreed upon supervision plan; 

(3) that any institution employing him 

shall submit, in conjunction with each 

application for PHS funds, or report, 

manuscript, or abstract involving PHSsupported research in which 

Respondent is involved, a certification 

to ORI that the data provided by 

Respondent are based on actual 

experiments or are otherwise 

legitimately derived and that the data, 

procedures, and methodology are 

accurately reported in the application, 

report, manuscript, or abstract; and 

(4) to exclude himself voluntarily 

from serving in any advisory capacity to 

PHS including, but not limited to, 

service on any PHS advisory committee, 

board, and/or peer review committee, or 

as a consultant. 

FOR FURTHER INFORMATION CONTACT: 

Acting Director, Office of Research 

Integrity, 1101 Wootton Parkway, Suite 

750, Rockville, MD 20852, (240) 453– 

8800. 

Donald Wright, 

Acting Director, Office of Research Integrity. 

[FR Doc. 2014–17889 Filed 7–29–14; 8:45 am] 

BILLING CODE 4150–31–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: ‘‘Care 

Coordination Quality Measure for 

Patients in the Primary Care Setting.’’ 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 September 29, 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 

Care Coordination Quality Measure for 

Patients in the Primary Care Setting 

Proposed Project 

‘‘Care Coordination Measure 

Development—Phase III’’ 

This project is Task Order #11 under 

the Agency for Healthcare Research and 

Quality (AHRQ) Prevention and Care 

Management Technical Assistance 

Center Indefinite Delivery Indefinite 

Quantity contract. The project, entitled 

‘‘Care Coordination Measure 

Development—Phase III’’, will develop 

a patient survey of the quality of care 

coordination for adults in primary care 

settings, i.e., the Care Coordination 

Quality Measure for Primary Care 

(CCQM–PC). The project will update the 

Care Coordination Measures Atlas 

(http://www.ahrq.gov/professionals/

systems/long-termcare/resources/

coordination/atlas/index.html). In 

combination with primary research, the 

project will use the Atlas and prior work 

that identified gaps in the measurement 

of care coordination to develop and 

pilot test a rigorous and 

psychometrically sound patient 

assessment (from the perspective of 

patient and family) of the quality of care 

coordination for adults within primary 

care settings—the CCQM–PC. The 

survey will address key care 

coordination domains; be appropriate 

for research; will set the stage for the 

future development of measures for 

quality reporting, accountability, and 

payment purposes; and be consistent 

with Consumer Assessment of 

Healthcare Providers and Systems 

(CAHPS®) principles. The instrument is 

to be developed, cognitively tested, 

revised and pilot tested. A stakeholder 

panel will provide input throughout the 

phases of the project. 

There are four explicit objectives for 

our analysis of the pilot-test data: 

• Evaluate the quality of the 

responses to the CCQM–PC survey 

(through item functioning analysis). 

• Determine how the items that ask 

for reports of patient experiences could 

be summarized into a smaller set of 

composite measures (through factor 

analysis). 

• Evaluate the measurement 

properties of the composite scales 

(assessment of reliability, validity, and 

variability of the measure). 

• Identify information (i.e., case mix 

adjusters) that should be used to adjust 

scores to ensure valid comparisons 

among primary care practices (PCPs). 

• Determine how CCQM–PC scores 

vary among practices that self-report 

processes of care that are more or less 

aligned with a medical home model. 

This study is being conducted by 

AHRQ through its contractor, American 

Institutes for Research (AIR), 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 quality 

measurement and improvement. 42 

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

Method of Collection 

Thirty primary care practices of 

different types and ownership 

configurations will be recruited to 

provide a patient sample to AHRQ’s 

contractor, AIR for the purpose of 

establishing the psychometrics of the 

CCQM–PC and understanding the 

relation of its domains to a practicelevel measure of processes of care, the 

Medical Home Index (Long Version, 

MHI–LV). The CCQM–PC will be 

conducted by mail with phone followup for nonrespondents. Survey 

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Federal Register / Vol. 79, No. 146 / Wednesday, July 30, 2014 / Notices 44173 

operations for the CCQM–PC will follow 

standard CAHPS practice: 

• Mail the questionnaire package, 

including a personalized letter 

introducing the study and explaining 

the respondent’s rights as a research 

participant. Include a postage-paid 

envelope to encourage participation. 

• Send a postcard reminder to 

nonrespondents 10 days after sending 

the questionnaire. 

• Send a second questionnaire with a 

reminder letter to those still not 

responding thirty days after the first 

mailing. 

• Begin follow-up by telephone with 

nonrespondents three weeks after 

sending the second questionnaire. 

Interviewers will attempt to locate 

respondents who have not responded to 

the mailed survey. 

• Verify telephone numbers for 

sample respondents prior to calling. 

• Make a maximum of 9 attempts by 

phone. 

• Include a toll-free number in the 

cards and letters for respondents to call 

if they have questions about the survey. 

The firm responsible for fielding the 

survey will establish a helpdesk that 

will start operating at the first mailing 

and that will remain open until close of 

fieldwork. 

• Answer incoming calls live during 

business hours and a recording machine 

will capture after hours calls. The afterhours calls will be returned next 

business day. 

• Ask two clinicians from each 

participating practice complete the 

MHI–LV by paper-and-pencil jointly 

and return the form to the AHRQ 

contractor. 

The information collected in the pilot 

survey will be used to test and improve 

the draft survey. The pilot design will 

support the standard suite of 

psychometric analyses conducted to 

identify and develop composite scoring 

algorithms as well as to provide 

evidence of the reliability and construct 

validity of the composite scores and any 

scores based on individual items. 

Additionally, the variations in 

composite scores and total CCQM–PC 

scores will be examined for any 

differences that may be correlated with 

variations in the practice’s selfassessment of its engagement in 

processes of care that are consistent 

with the medical home model. The 

analyses will include the following 

components: 

• Item functioning analysis 

• Confirmatory Factor Analysis 

• Exploratory Factor Analysis 

• Evaluation of the reliability, validity, 

and variability of composite and 

single-item scores 

• Case mix adjustment (if the data 

indicate this is needed). 

Because the survey items are being 

developed to measure specific aspects of 

care coordination in accordance with 

the domain framework developed 

through previous phases of AHRQ’s 

Care Coordination Measure 

Development portfolio, the factor 

structure of the survey items will be 

evaluated through multilevel 

confirmatory factor analysis. On the 

basis of the data analyses, items or 

factors may be dropped. Exploratory 

factor analysis is also planned. 

Data from the pilot survey will be 

used to make final adjustments to the 

CCQM–PC. The final survey instrument 

will be made publicly available, at no 

charge, to prospective users, for use in 

research projects that aim to assess care 

coordination as it relates to quality care 

and healthcare outcomes, thereby 

helping to expand the evidence base for 

the care coordination construct and its 

associated processes. There is value, 

given where the field is now, in 

developing a survey of reasonable 

length that can be used for research 

purposes, but also can serve as the 

‘‘parent’’ survey from which a smaller 

subset of items appropriate for quality 

improvement could be drawn. 

A well-developed, psychometricallysound, practical survey of adult 

patients’ experiences of care 

coordination in primary care settings, 

that covers key conceptual domains 

articulated through AHRQ’s past work 

in this area, will help generate evidence 

that is needed to understand the 

relationship between care coordination 

processes and health outcomes, in 

addition to offering a way to explore 

other critical questions regarding care 

coordination. 

The development of this researchfocused survey is a critical step in 

moving toward the future development 

of measures of care coordination in 

primary care settings that can be used 

for accountability purposes, including 

those submitted for consideration of 

endorsement by the National Quality 

Forum. This will ensure that the 

measures or measure set is useful from 

a public reporting perspective to a 

variety of potential stakeholders, 

including patients seeking providers 

that engage in care coordination 

practices supported by the evidence 

base. The key target audiences for the 

use of the survey are researchers and, 

ultimately, payers (including health 

insurance plans, employers, and entities 

such as the Centers for Medicare & 

Medicaid Services), although use by 

health systems and individual primary 

care practices is also envisioned. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the total estimated 

annualized burden hours for the 

CCQM–PC pilot survey (2,022 hours), 

including burden for survey 

respondents (1,890 hours) and practice 

staff (132 hours). With respect to the 

burden on CCQM–PC survey 

respondents, thirty practices will be 

sampled, with the survey sent to 375 

prospective respondents per sample. A 

40% response rate (in keeping with 

response rates on other CAHPS® and 

CAHPS®-like surveys of similar length 

and mode) will yield 150 respondents 

per practice. Total respondents were 

calculated by multiplying the number of 

practices by the respondents per 

practice, for a total of 4,500 (i.e., 150 × 

30 = 4,500). The survey has 102 items 

(79 assessment items, 4 items about 

healthcare services sought in the past 12 

months, and 19 items that assess 

participant characteristics such as 

demographics), with an estimated 

completion time of 25 minutes (.42 

hours) per survey response. This 

estimate is based on the length of 

previous CAHPS® surveys of 

comparable length that have been 

administered to similar populations. 

Burden hours for participating 

practices are calculated based on the 

total burden to one physician/

administrator and one other clinician to 

complete the MHI–LV. The measure 

author recommends that both physician 

and non-physician viewpoints are 

considered in the PCP’s response, thus 

the estimate is based on an assumption 

that two clinicians per practice will 

complete the MHI–LV process of care 

items together, with only one of the 

clinicians (i.e., the physician/

administrator) completing the items on 

practice characteristics. Contract staff 

from AIR will ensure that practices 

realize there is no burden to them on the 

MHI–LV other than the time required to 

fill out the MHI–LV tool (i.e., they can 

ignore the measure author’s reference in 

the instructions to a companion patient 

tool associated with the MHI–LV). 

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44174 Federal Register / Vol. 79, No. 146 / Wednesday, July 30, 2014 / Notices 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS FOR CCQM–PC SURVEY PILOT TEST BY ENTITY

CCQM–PC survey ........................................................................................... 4,500 1 0.42 1,890 

MHI–LV: 1 Physician/administrator ................................................................... 30 1 2.33 70 

MHI–LV: Non-physician clinician ..................................................................... 30 1 2.08 62 

Total .......................................................................................................... ........................ ........................ ........................ 2,022 

1The instructions for completing the MHI–LV recommend that a physician/administrator and a non-physician clinician each fill out the index 

separately. So, even though it is one form as reproduced in Appendix B, we have two rows in the table to describe the burden of the two individuals. There are a series of questions on the first two pages of the index which simply require administrative information and would only need to 

be completed once. We assume that the administrator would complete these and so the time required for the administrator to complete the MHI– 

LV is longer than that required for the clinician. 

Exhibit 2 shows the estimated 

annualized cost burden associated with 

the pilot survey administration. The 

total cost burden is estimated to be 

$51,228 for the one-time survey pilot. 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN FOR CCQM–PC SURVEY PILOT TEST BY ENTITY

Survey Respondents ................................................................................................................... 1,890 1 $22.33 $42,204 

Physician/Administrator ............................................................................................................... 70 2 88.43 6,190 

Non-physician Clinician ............................................................................................................... 62 3 45.71 2,834 

Total Overall ......................................................................................................................... 2,022 n/a 51,228 

1Average wage for civilian workers, http://www.bls.gov/news.release/ocwage.htm. 2Average wage for family and general practitioners, http://www.bls.gov/news.release/ocwage.htm. 3Average wage for nurse practitioners, http://www.bls.gov/news.release/ocwage.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 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: July 24, 2014. 

Richard Kronick, 

AHRQ Director. 

[FR Doc. 2014–17936 Filed 7–29–14; 8:45 am] 

BILLING CODE 4160–90–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[60Day–14–0963] 

Proposed Data Collections Submitted 

for Public Comment and 

Recommendations 

The Centers for Disease Control and 

Prevention (CDC), as part of its 

continuing effort to reduce public 

burden, invites the general public and 

other Federal agencies to take this 

opportunity to comment on proposed 

and/or continuing information 

collections, as required by the 

Paperwork Reduction Act of 1995. To 

request more information on the below 

proposed project or to obtain a copy of 

the information collection plan and 

instruments, call 404–639–7570 or send 

comments to Leroy Richardson, 1600 

Clifton Road, MS–D74, Atlanta, GA 

30333 or send an email to omb@cdc.gov. 

Comments submitted in response to 

this notice will be summarized and/or 

included in the request for Office of 

Management and Budget (OMB) 

approval. Comments are invited on: (a) 

Whether the proposed collection of 

information is necessary for the proper 

performance of the functions of the 

agency, including whether the 

information shall have practical utility; 

(b) the accuracy of the agency’s estimate 

of the burden of the proposed collection 

of information; (c) ways to enhance the 

quality, utility, and clarity of the 

information to be collected; (d) ways to 

minimize the burden of the collection of 

information on respondents, including 

through the use of automated collection 

techniques or other forms of information 

technology; and (e) estimates of capital 

or start-up costs and costs of operation, 

maintenance, and purchase of services 

to provide information. Burden means 

the total time, effort, or financial 

resources expended by persons to 

generate, maintain, retain, disclose or 

provide information to or for a Federal 

agency. This includes the time needed 

to review instructions; to develop, 

acquire, install and utilize technology 

and systems for the purpose of 

collecting, validating and verifying 

information, processing and 

maintaining information, and disclosing 

and providing information; to train 

personnel and to be able to respond to 

a collection of information, to search 

data sources, to complete and review 

the collection of information; and to 

transmit or otherwise disclose the 

information. Written comments should 

be received within 60 days of this 

notice. 

Proposed Project 

Colorectal Cancer Control Program 

Indirect/Non-Medical Cost Study (OMB 

No. 0920–0963, exp. 4/30/2014)— 

Reinstatement with Change—National 

Center for Chronic Disease Prevention 

and Health Promotion (NCCDPHP), 

Centers for Disease Control and 

Prevention (CDC). 

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