26964 Federal Register / Vol. 79, No. 91 / Monday, May 12, 2014 / Notices 

available. The meeting will also be 

webcast at www.bioethics.gov. 

Under authority of Executive Order 

13521, dated November 24, 2009, the 

President established the Commission. 

The Commission is an expert panel of 

not more than 13 members who are 

drawn from the fields of bioethics, 

science, medicine, technology, 

engineering, law, philosophy, theology, 

or other areas of the humanities or 

social sciences. The Commission 

advises the President on bioethical 

issues arising from advances in 

biomedicine and related areas of science 

and technology. The Commission seeks 

to identify and promote policies and 

practices that ensure scientific research, 

health care delivery, and technological 

innovation are conducted in a socially 

and ethically responsible manner. 

The main agenda item for the 

Commission’s seventeenth meeting is to 

discuss the BRAIN Initiative and 

ongoing work in neuroscience. 

The draft meeting agenda and other 

information about the Commission, 

including information about access to 

the webcast, will be available at 

www.bioethics.gov. 

The Commission welcomes input 

from anyone wishing to provide public 

comment on any issue before it. 

Respectful debate of opposing views 

and active participation by citizens in 

public exchange of ideas enhances 

overall public understanding of the 

issues at hand and conclusions reached 

by the Commission. The Commission is 

particularly interested in receiving 

comments and questions during the 

meeting that are responsive to specific 

sessions. Written comments will be 

accepted at the registration desk and 

comment forms will be provided to 

members of the public in order to write 

down questions and comments for the 

Commission as they arise. To 

accommodate as many individuals as 

possible, the time for each question or 

comment may be limited. If the number 

of individuals wishing to pose a 

question or make a comment is greater 

than can reasonably be accommodated 

during the scheduled meeting, the 

Commission may make a random 

selection. 

Written comments will also be 

accepted in advance of the meeting and 

are especially welcome. Please address 

written comments by email to info@

bioethics.gov, or by mail to the 

following address: Public Commentary, 

Presidential Commission for the Study 

of Bioethical Issues, 1425 New York 

Avenue NW., Suite C–100, Washington, 

DC 20005. Comments will be publicly 

available, including any personally 

identifiable or confidential business 

information that they contain. Trade 

secrets should not be submitted. 

Anyone planning to attend the 

meeting who needs special assistance, 

such as sign language interpretation or 

other reasonable accommodations, 

should notify Esther Yoo by telephone 

at (202) 233–3960, or email at 

Esther.Yoo@bioethics.gov in advance of 

the meeting. The Commission will make 

every effort to accommodate persons 

who need special assistance. 

Dated: April 29, 2014. 

Lisa M. Lee, 

Executive Director, Presidential Commission 

for the Study of Bioethical Issues. 

[FR Doc. 2014–10761 Filed 5–9–14; 8:45 am] 

BILLING CODE 4154–06–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: 

‘‘Updating and Expanding the AHRQ QI 

Toolkit for Hospitals.’’ In accordance 

with the Paperwork Reduction Act of 

1995, Public Law 104–13 (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 July 11, 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 

Updating and Expanding the AHRQ QI 

Toolkit for Hospitals 

AHRQ has developed sets of Quality 

Indicators (QIs) that can be used to 

document quality and safety conditions 

at U.S. hospitals. Three sets of QIs are 

particularly relevant for hospitals and 

include: The Inpatient Quality 

Indicators (IQIs), the Patient Safety 

Indicators (PSIs), and the Pediatric 

Quality Indicators (PDIs). 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. 

The PDIs measure the quality of 

pediatric health care, mainly focusing 

on preventable complications that occur 

as a consequence of hospitalization 

among pediatric patients. 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 

www.qualityindicators.ahrq.gov. 

Despite the availability of the QIs as 

tools to help hospitals assess their 

performance, many U.S. hospitals 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. To this end, RAND has 

previously contracted with AHRQ to 

develop an AHRQ Quality Indicators 

Toolkit for Hospitals (Toolkit). This 

Toolkit is publicly available and is 

posted on AHRQ’s Web site at http://

www.ahrq.gov/professionals/systems/

hospital/qitoolkit/index.html. The 

Toolkit assists hospitals in both using 

the QIs and improving the quality and 

safety of the care they provide, as 

measured by those indicators. As such, 

the Toolkit includes: (1) Instruction on 

how a hospital can apply the QIs to its 

inpatient data to estimate rates for each 

indicator; (2) methods the hospital can 

use to evaluate these QI rates for 

identifying opportunities for 

improvement; (3) strategies for 

implementing interventions (or 

evidence-based best practices); (4) 

methods to measure progress and 

performance on the QIs; (5) tools for 

evaluating the cost-effectiveness of these 

changes; and (6) discussion of the value 

of using the QIs for quality 

improvement as well as potential 

challenges and barriers to quality 

improvement efforts that incorporate the 

QIs and how to help overcome them. 


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Federal Register / Vol. 79, No. 91 / Monday, May 12, 2014 / Notices 26965 

OMB approval was obtained for the 

development and evaluation of the 

original Toolkit in 2012, Development 

and Evaluation of AHRQ’s Quality 

Indicators Improvement Toolkit (OMB # 

0935–0164), which consisted of a 

protocol very similar to the one 

described in this statement. 

Since the release of the Toolkit in 

2012, the QIs have been updated and 

expanded, best practices have advanced, 

and many hospitals have improved their 

understanding of their quality 

improvement needs as well as increased 

their familiarity with the use of the 

Toolkit. These factors all point to the 

critical need to update the Toolkit. 

AHRQ has funded RAND, which 

partners with the University 

HealthSystem Consortium (UHC), to 

update and expand the Toolkit, and 

field test the updated Toolkit with 

hospitals as they carry out initiatives 

designed to improve performance on the 

QIs. 

This research has the following goals: 

(1) To assess the usability of the 

updated Toolkit for hospitals—with an 

emphasis on the Pediatric Quality 

Indicators (PDI)—in order to improve 

the Toolkit, and 

(2) To examine hospitals’ experiences 

in implementing interventions to 

improve their performance on the 

AHRQ QIs, the results of which will be 

used to guide successful future 

applications of the Toolkit. 

This study is being conducted by 

AHRQ through its contractor, the RAND 

Corporation, under contract number 

HHSA290201000017I, 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: 

(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 updated 

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 updated Toolkit. This information 

will be used in the revisions of the 

updated Toolkit following the end of the 

field test. 

All the information obtained from the 

proposed data collection will be used to 

strengthen the updated Toolkit before 

finalizing and disseminating it to 

hospitals for their use. First, information 

will be collected from the six hospitals 

participating in the Toolkit field test 

about their experiences in implementing 

performance improvements related to 

the AHRQ QIs, which will be used to 

prepare experiential case examples for 

inclusion in the Toolkit as a resource for 

other hospitals. Second, feedback will 

be elicited from them about the usability 

of the Toolkit, which will be applied to 

modify and refine the Toolkit so that it 

is as responsive as possible to the needs 

and priorities of the hospitals for which 

it is intended. 

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 with the six hospitals’ 

implementation teams at the start of the 

year. Each hospital’s implementation 

team is expected to consist of about 5 

people. At the end of the year, post-test 

interviews that last one hour each and 

use the same protocol as the pre-test 

interviews will be conducted during site 

visits at the six hospitals with the 

implementation team. Thus these 5 

people of the implementation team at 

each hospital will be interviewed twice, 

both pre- and post-field test. At the posttest site visits, data will also be 

collected through one-hour interviews 

performed separately with 4 key 

stakeholder groups—physicians, nurses, 

clerks, and others—that are not on the 

implementation team. Each stakeholder 

group is expected to consist of about 5 

people. Thus these 20 people from the 

4 stakeholder groups at each hospital 

will be interviewed once for one hour 

post-field test. Interviewing these 

additional stakeholder groups will 

ensure that we gather information on 

stakeholder variations in perceptions 

and experiences, 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 

total burden is estimated to be 240 

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 $7,179. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Data collection Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Pre/Post-Test Interview Protocol with Implementation Team ......................... 30 2 1 60 


emcdonald on DSK67QTVN1PROD with NOTICES
26966 Federal Register / Vol. 79, No. 91 / Monday, May 12, 2014 / Notices 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS—Continued 

Data collection Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Pre/Post-Test Interview Protocol with Stakeholder Groups ............................ 120 1 1 120 

Quarterly Update Protocol ............................................................................... 12 3 1 36 

Usability Testing Protocol ................................................................................ 24 1 1 24 

Total .......................................................................................................... 186 NA NA 240 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Data collection Number of 

respondents 

Total burden 

hours 

Average 

hourly 

wage rate * 

Total cost 

burden 

Pre/Post-Test Interview Protocol (Implementation Team and Stakeholder 

Groups) ........................................................................................................ 150 180 $29.91 $5,384 

Quarterly Update Protocol ............................................................................... 12 36 29.91 1,077 

Usability Testing Protocol ................................................................................ 24 24 29.91 718 

Total .......................................................................................................... 186 240 NA 7,179

* Based upon the mean of the average wages taken from an average of hourly rates for occupations likely to be involved in the QI process 

(registered nurses, nurse practitioners, medical records and health information technicians, statisticians, and health technologists and technicians). Statistics are taken from the General Medical and Surgical Hospitals industry category in the May 2012 National Industry-Specific Occupational Employment and Wage Estimates from the Bureau of Labor Statistics, U.S. Department of Labor, accessed on January 22, 2014 

[www.bls.gov/oes/]. 

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: May 1, 2014. 

Richard Kronick, 

AHRQ Director. 

[FR Doc. 2014–10752 Filed 5–9–14; 8:45 am] 

BILLING CODE 4160–90–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Notice of Meetings 

AGENCY: Agency for Healthcare Research 

and Quality (AHRQ), HHS. 

ACTION: Notice of Five AHRQ 

Subcommittee Meetings. 

SUMMARY: The subcommittees listed 

below are part of AHRQ’s Health 

Services Research Initial Review Group 

Committee. Grant applications are to be 

reviewed and discussed at these 

meetings. Each subcommittee meeting 

will commence in open session before 

closing to the public for the duration of 

the meeting. These meetings will be 

closed to the public in accordance with 

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

552b(c)(4), and 5 U.S.C. 552b(c)(6). 

DATES: See below for dates of meetings: 

1. Healthcare Safety and Quality 

Improvement Research (HSQR) 

Date: June 17–18, 2014 (Open from 

8:00 a.m. to 8:30 a.m. on June 17 and 

closed for remainder of the meeting). 

2. Healthcare Effectiveness and 

Outcomes Research (HEOR) 

Date: June 18, 2014 (Open from 8:00 

a.m. to 8:30 a.m. on June 18 and closed 

for remainder of the meeting). 

3. Health Care Research and Training 

(HCRT) 

Date: June 19–20, 2014 (Open from 

8:00 a.m. to 8:30 a.m. on June 19 and 

closed for remainder of the meeting). 

4. Healthcare Information Technology 

Research (HITR) 

Date: June 25–27, 2014 (Open from 

5:30 p.m. to 6:00 p.m. on June 25 and 

closed for remainder of the meeting). 

5. Health System and Value Research 

(HSVR) 

Date: June 26, 2014 (Open from 8:30 

a.m. to 9:00 a.m. on June 26 and closed 

for remainder of the meeting). 

ADDRESSES: Hilton Washington DC/

Rockville Hotel & Executive Meeting 

Center, 1750 Rockville Pike, Rockville, 

MD 20852. 

FOR FURTHER INFORMATION CONTACT: (To 

obtain a roster of members, agenda or 

minutes of the non-confidential portions 

of the meetings.) 

Mrs. Bonnie Campbell, Committee 

Management Officer, Office of 

Extramural Research Education and 

Priority Populations, AHRQ, 540 

Gaither Road, Suite 2000, Rockville, 

Maryland 20850, Telephone (301) 427– 

1554. 

SUPPLEMENTARY INFORMATION: In 

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

Federal Advisory Committee Act (5 

U.S.C. App. 2), AHRQ announces 

meetings of the scientific peer review 

groups listed above, which are 

subcommittees of AHRQ’s Health 


emcdonald on DSK67QTVN1PROD with NOTICES