[Federal Register Volume 89, Number 183 (Friday, September 20, 2024)]
[Notices]
[Pages 77153-77155]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-21564]


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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: Information collection notice.

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SUMMARY: In compliance with the Paperwork Reduction Act of 1995, 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 reinstatement without change of the information 
collection project Evaluating the Implementation of PCOR to Increase 
Referral, Enrollment, and Retention through Automatic Referral to 
Cardiac Rehabilitation (CR) with Care Coordinator OMB No. 0935-0252 for 
which approval has expired. The reinstatement of this previously 
approved PRA collection for which approval has expired is required in 
order to discontinue this collection.

DATES: Comments on this notice must be received by November 19, 2024.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by email at 
<a href="/cdn-cgi/l/email-protection#d785928798858384949b929685969994929891919e94928597b6bfa5a6f9bfbfa4f9b0b8a1"><span class="__cf_email__" data-cfemail="d48691849b8680879798919586959a97919b92929d97918694b5bca6a5fabcbca7fab3bba2">[email protected]</span></a>.
    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 
<a href="/cdn-cgi/l/email-protection#722037223d202621313e373320333c31373d34343b31372032131a00035c1a1a015c151d04"><span class="__cf_email__" data-cfemail="a7f5e2f7e8f5f3f4e4ebe2e6f5e6e9e4e2e8e1e1eee4e2f5e7c6cfd5d689cfcfd489c0c8d1">[email protected]</span></a>.

SUPPLEMENTARY INFORMATION: 
    Title of Information Collection: Evaluating the Implementation of 
PCOR to Increase Referral, Enrollment, and Retention through Automatic 
Referral to Cardiac Rehabilitation (CR) with Care Coordinator.
    OMB No.: 0935-0252.
    Type of Request: Reinstatement without change to discontinue the 
collection.
    The aim of this project, known as TAKEheart, was to (a) raise 
awareness about the benefits of cardiac rehabilitation (CR) after 
myocardial infarction or coronary revascularization, then to (b) spread 
knowledge about the best practices to increase referrals to CR, and, 
finally, (c) to increase CR uptake.
    AHRQ evaluated TAKEheart to assess:
    <bullet> the extent and effectiveness of the dissemination and 
implementation efforts
    <bullet> the uptake and usage of Automatic Referral with Care 
Coordination and
    <bullet> levels of referral to CR at the end of the intervention.
    Evaluation results were used to improve the intervention and to 
provide guidance for future AHRQ dissemination and implementation 
projects. Two cohorts of ``Partner Hospitals,'' up to 125 hospitals in 
total, engaged in efforts to implement Automatic Referral with Care 
Coordination over twelve-month periods. The evaluation ascertained the 
diversity of hospitals engaged in the activities that contributed to 
(or hindered) their efforts, and the types of support which they 
reported having been most (and least) useful. This information was used 
to improve recruitment, technical assistance, and tools for the second 
cohort.
    In addition, hospitals--including those involved in the 
implementation--were invited to attend Affinity Group virtual meetings 
organized around specific topics of interest which are not intrinsic to 
Automatic Referral with Care Coordination. Hospital staff engaged in 
Affinity Groups created a vibrant Learning Community. The evaluation 
determined which Affinity Groups engaged the most participants of the 
Learning Community, and which resources participants determined the 
most useful. This information was used to develop resources which were 
available on a new, permanent website dedicated to improving CR.
    This study was conducted by AHRQ through its contractor, Abt 
Associates Inc., pursuant to AHRQ's statutory authority to disseminate 
government-funded research relevant to comparative clinical 
effectiveness research. 42 U.S.C. 299b-37(a).

Method of Collection

    To collect data on the many facets of the intervention, the 
collection implemented multiple data collection tools, each of which 
had a specific purpose and set of respondents.
    1. Partner Hospital Champion Survey. Each Partner Hospital 
designated a ``Champion'' who coordinated activities associated with 
implementing Automatic Referral with Care Coordination at the hospital 
and provide the Champion's name and email address. Champions could have 
had any role in the hospital, although they were expected to be in 
relevant positions, such as cardiologists or quality improvement 
managers. We conducted online surveys of 125 Champions (one Champion 
per hospital). We used the email addresses to send the Champion a 
survey at two points: seven months after the start of implementation 
and at the end of the 12-month implementation period. The first survey 
focused on four constructs. First, it captured data about the hospital 
context, such as whether it had prior experience customizing an EMR or 
is a safety net hospital. Second,

[[Page 77154]]

it addressed the hospital's decision to participate in TAKEheart. 
Third, it captured data on the CR programs the hospital refers to, 
whether the number or type has changed, and why. Fourth, it collected 
feedback on the training and technical assistance received. The second 
survey focused on three constructs. The first construct collected 
feedback on the TAKEheart components, including training, technical 
assistance, and use of the website. The second construct asked about 
the hospitals' response to participating in TAKEheart, such as changes 
to referral workflow or CR programs. The third construct asked those 
Partner Hospitals that had not completed the process of implementing 
Automatic Referral with Care Coordination whether they anticipated 
continuing to work towards that goal and their confidence in 
succeeding.
    2. Partner Hospital Interviews.
    a. Interviews with Partner Hospital Champions. We selected, from 
each cohort, eight Partner Hospitals which demonstrated a strong 
interest in addressing underserved populations or reducing disparities 
in participation in cardiac rehabilitation. We conducted a key 
informant interview with the Champion of each selected Partner Hospital 
to delve into how they were addressing the needs of underserved 
populations by implementing Automatic Referral with Care Coordination.
    b. Interviews with Partner Hospital cardiologists. We selected, 
from each cohort, eight hospitals based on criteria selected in 
conversation with AHRQ, such as hospitals which serve specific 
populations, or have the same EMRs, which informed their experience 
customizing the EMR. We conducted semi-structured interviews with one 
cardiologist at each of the selected hospitals twice. In the second 
month of the cohort implementation, we asked about their needs, 
concerns, and expectations of the program. In the 11th month of the 
cohort implementation, we determined whether their concerns were 
addressed appropriately and adequately.
    c. Interviews with Partner Hospitals that withdraw. We expected 
that a small number of Partner Hospitals would withdraw from the 
cohort. We identified these hospitals by their lack of participation in 
training and technical assistance events; Technical Assistance (TA) 
Providers confirmed their withdrawal. We interviewed up to nine 
withdrawing hospitals to better understand the reason for withdrawal 
(e.g., a merger resulted in a loss of support for the intervention, 
Champion left), as well as facilitators and barriers of each hospitals' 
approach to implementing Automatic Referral with Care Coordination. If 
more than nine hospitals withdrew, we ceased interviewing.
    3. Learning Community Participant Survey. We conducted online 
surveys of 250 currently active Learning Community participants at two 
points in time, in months 18 and 31 of the project. We administered the 
survey by sending a link to an online survey to email addresses entered 
by virtual meeting participants during registration. The email 
described the purpose of the survey.
    4. Learning Community Follow-up Survey. We conducted a brief online 
survey with up to 15 Learning Community participants following the 
final virtual meeting for each of 10 Affinity Group, to ascertain 
whether the hospitals were able to act on what they learned during the 
session. The total sample was 150 Learning Community participants.

Estimated Annual Respondent Burden

    Exhibit 1 presents estimates of the reporting burden hours for the 
data collection efforts. Time estimates were based on prior experiences 
and what could reasonably be requested of participating health care 
organizations. The number of respondents listed in column A, Exhibit 1 
reflects a projected 90% response rate for data collection effort 1, 
and an 80% response rate for efforts 3 and 4 below.
    1. Partner Hospital Champion Survey. We assumed 113 hospital 
champions would complete the survey based on a 90% response rate. It 
was expected to take up to 45 minutes to complete for a total of 169.5 
hours to complete.
    2. Partner Hospital Interviews. In-depth interviews occured with 
select Partner Hospital staff.
    a. Interviews with Partner Hospital Champions. We had a single, 90 
minute interview with eight Partner Hospital Champions, in each cohort, 
from Partner Hospital which have a common characteristic of particular 
interest, for a total of 24 hours.
    b. Interviews with Partner Hospital cardiologists. We held 
individual, up-to-30 minute interviews with eight cardiologists, twice 
in each cohort, for a total of 16 hours.
    c. Interviews with Partner Hospitals that withdraw. We interviewed 
up to nine withdrawing hospitals for no more than 20 minutes to better 
understand the reason for withdrawal as well as facilitators and 
barriers, for a total of 2.7 hours.
    3. Learning Community Participant Survey. We assumed 200 Learning 
Community participants would complete the survey based on an 80% 
response rate. It was expected to take up to 15 minutes to complete 
each survey for a total of 100 hours.
    Learning Community Follow-up Survey. We conducted a brief, up to 10 
minute, online survey of participants of each of just ten selected 
Affinity Groups at two months after the virtual meeting. We assumed 120 
Learning Community participants would complete the survey based on an 
80% response rate. It was expected to take up to 15 minutes to complete 
each survey for a total of 20.4 hours.

                                  Exhibit 1--Estimated Annualized Burden Hours
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                                                                   B. Number of
   Data collection method or project activity      A. Number of    responses per   C. Hours per      D. Total
                                                    respondents     respondent       response      burden hours
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1. Partner Hospital Champion Survey *...........             113               2            0.75           169.5
2a. Interviews with Partner Hospital Champions..              16               1             1.5            24.0
2b. Interviews with Partner Hospital                          16               2             0.5            16.0
 Cardiologists..................................
2c. Interviews with Partner Hospitals that                     9               1             0.3             2.7
 withdraw.......................................
3. Learning Community Survey **.................             200               2            0.25           100.0
4. Learning Community Follow-up Survey **.......             120               1            0.17            20.4
                                                 ---------------------------------------------------------------
    Total.......................................             474  ..............  ..............           332.6
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* Number of respondents (Column A) reflects a sample size assuming a 90% response rate for this data collection
  effort.
** Number of respondents (Column A) reflects a sample size assuming an 80% response rate for this data
  collection effort.


[[Page 77155]]

    Exhibit 2, below, presents the estimated annualized cost burden 
associated with the respondents' time to participate in this research. 
The total cost burden was estimated to be about $21,497.

                                   Exhibit 2--Estimated Annualized Cost Burden
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                                                   A. Number of      B. Total     Average hourly    Total cost
   Data collection method or project activity       respondents    burden hours      wage rate        burden
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1. Partner Hospital Champion Survey *...........             113           169.5          $72.27         $12,250
2a. Interviews with Partner Hospital Champions..              16            24.0           72.27           1,734
2b. Interviews with Partner Hospital                          16            16.0           96.58           1,545
 Cardiologists..................................
2c. Interviews with Partner Hospitals that                     9             2.7           72.27             195
 withdraw.......................................
3. Learning Community Survey **.................             200           100.0           47.95           4,795
4. Learning Community Follow-up Survey **.......             120            20.4           47.95             978
                                                 ---------------------------------------------------------------
    Total.......................................             474           332.6  ..............          21,497
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* Number of respondents (Column A) reflects a sample size assuming a 90% response rate for this data collection
  effort.
** Number of respondents (Column A) reflects a sample size assuming an 80% response rate for this data
  collection effort.

Request for Comments

    In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-
3520, 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's 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 17, 2024.
Marquita Cullom,
Associate Director.
[FR Doc. 2024-21564 Filed 9-19-24; 8:45 am]
BILLING CODE 4160-90-P


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