16132 Federal Register / Vol. 75, No. 61 / Wednesday, March 31, 2010 / Notices 

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: March 19, 2010. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2010–6776 Filed 3–30–10; 8:45 am] 

BILLING CODE 4160–90–M 

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: 

‘‘Reductions of Infection Caused by 

Carbapenem Resistant 

Enterobacteriaceae (KPC) Producing 

Organisms through the Application of 

Recently Developed CDC/HICPAC 

Recommendations.’’ In accordance with 

the Paperwork Reduction Act, 44 U.S.C. 

3501–3520, AHRQ invites the public to 

comment on this proposed information 

collection. 

DATES: Comments on this notice must be 

received by June 1, 2010. 

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 

e-mail at 

doris.lefkowitz@AHRQ.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

Reductions of Infection Caused by 

Carbapenem Resistant 

Enterobacteriaceae (KPC) Producing 

Organisms Through the Application of 

Recently Developed CDC/HICPAC 

Recommendations 

Healthcare Acquired Infections (HAIs) 

caused almost 100,000 deaths among 

the 2.1 million people who acquired 

infections while hospitalized in 2000, 

and HAI rates have risen relentlessly 

since then. On March 20, 2009, the 

Centers for Disease Control (CDC) and 

the Healthcare Infections Control 

Practices Advisory Committee (HICPAC) 

developed infection control (IC) 

guidance for Klebsiella pneumonia 

carbapenemase-producing (KPC) 

isolates, as they have been rapidly 

emerging as a significant challenge in 

healthcare settings. The danger of these 

bacteria is that they are resistant to 

carbapenem (a class of beta-lactam 

antibiotics with a broad spectrum of 

antibacterial activity) and cannot be 

treated by the most commonly 

prescribed antibiotics. Limited 

treatment options mean that infections 

caused by carbapenem resistant bacteria 

result in substantial mortality and 

morbidity. 

The CDC and HICPAC 

recommendations draw on infection 

control strategies which have been 

applied to these pathogens in other 

settings, and other evidence based 

strategies in infection control. There has 

been little research, however, on the 

implementation of control strategies to 

prevent the spread of these KPC 

infections. The goal of this project is to 

understand how these recommendations 

can best be implemented and how 

effective these recommendations will be 

in practice. This research will advance 

private and public efforts to improve 

health care quality by improving 

measures to control the spread of a 

dangerous organism. This research will 

also provide data for the development of 

an implementation toolkit that hospitals 

can use to prevent the spread of 

carbapenem resistant bacteria. The 

toolkit may include the following types 

of resources: General information about 

the implementation of evidenced-based 

clinical practices, resource materials, 

and tools and methods that users can 

adopt to conduct point prevalence 

surveys, protocols and tools that users 

can adopt to specify when active KPC 

surveillance is needed, and resources 

for approaching the problem as a teambased quality-improvement effort. 

OMB clearance will be sought for this 

toolkit once it is developed. 

This study is being conducted by 

AHRQ through its contractor, Boston 

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 

This project will include the 

following data collections from the 

intensive care unit (ICU) staff within 

each of three participating hospitals: 

(1) Pre-intervention focus groups will 

be conducted separately with managers 

and staff. The purpose of these focus 

groups is to identify potential problems 

in the implementation that can be 

addressed through various means (e.g., 

additional education, other changes in 

process). Another purpose is to 

understand the existing approach to 

quality improvement, the connection(s) 

between overall approach to quality 

improvement and to KPC infection 

control practices, current practices at 

the hospital of quality reporting and 

accountability, and constraints and 

obstacles to quality improvement as 

seen in their roles. Staff members 

identified for the focus groups will be 

those with the most first-hand 

knowledge of existing quality 

improvement efforts, and KPC infection 

control practices. 

(2) Clinical staff survey. Factors 

identified in the pre-intervention focus 

groups will be used to inform the 

development of a self-administered 

survey of staff knowledge of and 

attitudes toward KPC surveillance and 

infection control procedures. 

Respondents will be health care workers 

on the units where these new guidelines 

have been implemented. Findings from 

the survey will be used to assess barriers 

perceived by the staff, potential 

differences across units, and potential 

differences by employee/occupational 

group. 

(3) Post-intervention focus groups (6 

months after implementation of new 

KPC IC guidelines) will be conducted 

separately with managers and staff. The 

purpose of these focus groups is to 

identify actual problems experienced in 

the initial implementation and possible 

measures to address, and to identify 

successful practices to include in a 

toolkit that hospitals can use to 

implement the CDC and HICPAC 

recommendations. 

In addition to developing a toolkit, 

AHRQ plans to disseminate the lessons 


jlentini on DSKJ8SOYB1PROD with NOTICES
Federal Register / Vol. 75, No. 61 / Wednesday, March 31, 2010 / Notices 16133 

learned from this project about how 

hospitals can best implement the CDC 

guidance for KPC screening and 

infection control, in order to inform 

efforts to change practice in this area. 

Estimated Annual Respondent Burden 

The estimated annualized burden 

hours for respondents to participate in 

this two year research project are 

presented in Exhibit 1. Pre-intervention 

focus groups with clinical staff will be 

conducted with 18 staff members (an 

average of 9 per year for 2 years) from 

each of the 3 participating hospitals and 

will take about 1 hour. Pre-intervention 

focus groups with also be conducted 

with 2 managers (an average of 1 per 

year for 2 years) from each hospital and 

will take about an hour to complete. 

The clinical staff survey will be 

administered to 20 clinical staff (an 

average of 10 per year for 2 years) from 

each hospital and will take 15 minutes 

to complete. 

Finally, respondents from the preintervention focus groups will 

participate in post-intervention focus 

groups approximately four months after 

the initiation of the intervention. They 

will not last more than an hour each. 

The total annualized burden hours are 

estimated to be 68 hours. 

Exhibit 2 shows the estimated 

annualized cost burden associated with 

the respondents’ time to participate in 

this research. The total annualized cost 

burden is estimated to be $3,108. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Data collection Number of 

respondents 

Number of responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Pre-intervention focus groups with clinical staff * ............................................ 3 9 1 27 

Pre-intervention focus groups with managers * ............................................... 3 1 1 3 

Clinical staff survey .......................................................................................... 3 10 15/60 8 

Post-intervention focus groups with clinical staff * ........................................... 3 9 1 27 

Post-intervention focus groups with managers * ............................................. 3 1 1 3 

Total .......................................................................................................... 15 n/a n/a 68 

* Individuals that cannot attend the focus groups will be interviewed one-on-one. Clinical staff includes IC leaders, QI team members and unit 

staff. Managers include the chief nursing officer and chief medical officer. 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Data collection Number of 

respondents 

Total burden 

hours 

Average hourly wage rate Total cost 

burden 

Pre-intervention focus groups with clinical staff .............................................. 3 27 * $36.73 $992 

Pre-intervention focus groups with managers ................................................. 3 3 ** 138.38 415 

Clinical staff survey .......................................................................................... 3 8 * 36.73 294 

Post-intervention focus groups with clinical staff ............................................. 3 27 * 36.73 992 

Post-intervention focus groups with managers ............................................... 3 3 ** 138.38 415 

Total .......................................................................................................... 15 68 na 3,108 

* Based upon the mean hourly wage for Registered Nurses in Nassau and Suffolk County, NY as reported by the Bureau of Labor Statistics in 

May 2008. 

** Based on report of a private survey of HR departments conducted in November 2009 in New York, NY published by http://www.salary.com; 

3 chief nursing officers at $101.14/hr and 3 chief medical officers at $175.61/hour. 

Estimated Annual Costs to the Federal 

Government 

Exhibit 3 shows the annualized and 

total cost to the federal government for 

this two year research project. Project 

development covers steps taken to 

revise the research plan and begin 

implementation. The total cost is 

estimated to be $500,001. 

EXHIBIT 3—ANNUALIZED AND TOTAL COST TO THE FEDERAL GOVERNMENT

Cost component Annualized cost Total cost 

Project Management .................................................................................................................................... $125,526 $251,052 

Project Development ................................................................................................................................... 54,622 109,244 

Data Collection Activities ............................................................................................................................. 41,864 83,728 

Travel ........................................................................................................................................................... 4,000 8,000 

Overhead ..................................................................................................................................................... 23,754 47,507 

Total ...................................................................................................................................................... 250,001 500,001 

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 


jlentini on DSKJ8SOYB1PROD with NOTICES
16134 Federal Register / Vol. 75, No. 61 / Wednesday, March 31, 2010 / Notices 

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: March 19, 2010. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2010–6778 Filed 3–30–10; 8:45 am] 

BILLING CODE 4160–90–M 

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: 

‘‘Collection of Information for Agency 

for Healthcare Research and Quality’s 

(AHRQ) Consumer Assessment of 

Healthcare Providers and Systems 

(CAHPS®) Health Plan Survey 

Comparative Database.’’ 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 January 25th, 2010 and 

allowed 60 days for public comment. No 

comments were 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 30, 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 email 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.letkowitz@AHRQ.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

Collection of Information for Agency 

for Healthcare Research and Quality’s 

(AHRQ) Consumer Assessment of 

Healthcare Providers and Systems 

(CAHPS) Health Plan Survey 

Comparative Database 

The Agency for Healthcare Research 

and Quality (AHRQ) requests that the 

Office of Management and Budget 

(OMB) approve, under the Paperwork 

Reduction Act of 1995, AHRQ’s 

collection of information for the AHRQ 

Consumer Assessment of Healthcare 

Providers and Systems (CAHPS) 

Database for Health Plans. The CAHPS 

Health Plan Database consists of data 

from the AHRQ CAHPS Health Plan 

Survey. 

Health plans in the U.S. are asked to 

voluntarily submit data from the survey 

to AHRQ, through its contractor, Westat. 

The CAHPS Database was developed by 

AHRQ in 1998 in response to requests 

from health plans, purchasers, and the 

Centers for Medicare & Medicaid 

Services (CMS) to provide comparative 

data to support public reporting of 

health plan ratings, health plan 

accreditation and quality improvement. 

The CAHPS Health Plan Survey is a 

tool for collecting standardized 

information on enrollees’ experiences 

with health plans and their services. 

The development of the CAHPS Health 

Plan Survey began in 1995, when AHRQ 

awarded the first set of CAHPS grants to 

Harvard, RTI, and RAND. In 1997 the 

CAHPS 1.0 survey was released by the 

CAHPS Consortium. The CAHPS 

Consortium refers to the research 

organizations involved in the 

development, dissemination, and 

support of CAHPS products. The 

current Consortium includes AHRQ, 

CMS, RAND, Yale School of Public 

Health, and Westat. 

Since that time, the Consortium has 

clarified and updated the survey 

instrument to reflect field test results; 

feedback from industry experts; reports 

from health plan participants, data 

collection vendors, and other users; and 

evidence from cognitive testing and 

focus groups. In November 2006, the 

CAHPS Consortium released the latest 

version of the instrument: The CAHPS 

Health Plan Survey 4.0. The 

development of this update to the 

Health Plan Survey has been part of the 

‘‘Ambulatory CAHPS (A–CAHPS) 

Initiative,’’ which arose as a result of 

extensive research conducted with 

users. AHRQ released the CAHPS 

Health Plan Survey 4.0, along with 

guidance on how to customize and 

administer it. The National Quality 

Forum endorsed the 4.0 version of the 

Health Plan Survey in July 2007. 

The CAHPS Health Plan Database 

uses data from AHRQ’s standardized 

CAHPS Health plan survey to provide 

comparative results to health care 

purchasers, consumers, regulators and 

policy makers across the country. The 

Database also provides data for AHRQ’s 

annual National Healthcare Quality and 

National Healthcare Disparities Reports. 

Voluntary participants include public 

and private employers, State Medicaid 

agencies, State Children’s Health 

Insurance Programs (SCHIP), CMS, and 

individual health plans. 

The collection of information for the 

CAHPS Database for Health Plans is 

being conducted pursuant to AHRQ’s 

statutory authority to conduct and 

support research on health care and 

systems for the delivery of such care, 

including activities with respect to the 

quality, effectiveness, efficiency, 

appropriateness and value of health care 

services. See 42 U.S.C. 299a(a)(1). 

Method of Collection 

Information for the CAHPS Health 

Plan Database has been collected by 

AHRQ through its contractor Westat on 

an annual basis since 1998. Health plans 

are asked to voluntarily submit their 

data to the comparative database in June 

of each year. The data are cleaned with 

standardized programs, then aggregated 

and used to produce comparative results 

for commercial (adult and child), 

Medicaid (adult and child), and 

Medicare (adult) populations for the two 

most recent years. In addition, 

individual participant reports are 

produced that display the participating 

organizations’ own results compared to 

appropriate comparisons derived from 

the National, regional and product-type 

distributions on a password-protected 

section of the online reporting system. 

The CAHPS Health Plan Database 

receives the data from three sources. 

First, commercial health plan data is 

purchased by the CAHPS Health Plan 

Database directly from the National 

Committee for Quality Assurance 

(NCQA). The data is collected by NCQA 

from those who participate in its 

accreditation program. Second, 

Medicare data is provided by CMS 

through an agency data use agreement. 

The Medicare data is collected by CMS 


jlentini on DSKJ8SOYB1PROD with NOTICES