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[Federal Register Volume 79, Number 200 (Thursday, October 16, 2014)]
[Notices]
[Pages 62152-62155]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-24513]

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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: ``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.

[[Page 62153]]

This proposed information collection was previously published in the 
Federal Register on July 30th, 2014 and allowed 60 days for public 
comment. AHRQ received and responded to comments from two members of 
the public. The purpose of this notice is to allow an additional 30 
days for public comment.

DATES: Comments on this notice must be received by November 17, 2014.

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).

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 
(CAMPS) 0 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 five 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 AIR for 
the purpose of establishing the psychometrics of the CCQM-PC and 
understanding the relation of its domains to a practice-level measure 
of processes of care, the Medical Home Index (Long Version, MHI-LV). 
The CCQM-PC will be conducted by mail with phone follow-up for 
nonrespondents. Survey 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 who have still not responded 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 after-hours 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 
self-assessment 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

[[Page 62154]]

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, psychometrically sound, 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 research-focused 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 II+ and CAHPSS-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 x 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[supreg] 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).

              Exhibit 1--Estimated Annualized Burden Hours for CCQM-PC Survey Pilot Test by Entity
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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
----------------------------------------------------------------------------------------------------------------
\1\ The 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

    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
----------------------------------------------------------------------------------------------------------------
 
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Survey Respondents..............................................           1,890      \1\ $22.33         $42,204
Physician/Administrator.........................................              70       \2\ 88.43             190
Non-physician Clinician.........................................              62       \3\ 45.71           2,834
                                                                 -----------------------------------------------
    Total Overall...............................................            2022             n/a          51,228
----------------------------------------------------------------------------------------------------------------
\1\ Average wage for civilian workers, http://www.bls.gov/news.release/ocwage.htm.
\2\ Average wage for family and general practitioners, http://www.bls.gov/news.release/ocwage.htm.
\3\ Average 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

[[Page 62155]]

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: October 6, 2014.
Richard Kronick,
Director.
[FR Doc. 2014-24513 Filed 10-15-14; 8:45 am]
BILLING CODE 4160-90-M
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