```

[Federal Register Volume 79, Number 149 (Monday, August 4, 2014)]
[Notices]
[Pages 45194-45196]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-18297]

-----------------------------------------------------------------------

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.
    This proposed information collection was previously published in 
the Federal Register on May 12th 2014 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 September 3, 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. 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 health 
care and on systems for the delivery of such care, including activities 
with respect to the quality, effectiveness, efficiency, appropriateness 
and value of health care 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.

[[Page 45195]]

    (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 
five 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. The five people of the implementation team at each 
hospital will be interviewed twice, both pre- and post-field test. At 
the post-test site visits, data will also be collected through one-hour 
interviews performed separately with four key stakeholder groups--
physicians, nurses, clerks, and others--that are not on the 
implementation team. Each stakeholder group is expected to consist of 
about five people. These 20 people from the four stakeholder groups at 
each hospital will be interviewed once in a one hour post-field test. 
Interviewing these additional stakeholder groups will ensure that 
information is gathered 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 two 
hospital staff members from each hospital during the year (in months 3, 
6, and 9). The usability testing protocol will be administered to four 
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
----------------------------------------------------------------------------------------------------------------
                                                                     Number of
                 Data collection                     Number of     responses per     Hours per     Total burden
                                                    respondents     respondent       response          hours
----------------------------------------------------------------------------------------------------------------
Pre/Post-Test Interview Protocol with                         30               2               1              60
 Implementation Team............................
Pre/Post-Test Interview Protocol with                        120               1               1             120
 Stakeholder Groups.............................
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
----------------------------------------------------------------------------------------------------------------
                                                     Number of     Total burden   Average hourly    Total cost
                 Data collection                    respondents        hours        wage rate *       burden
----------------------------------------------------------------------------------------------------------------
Pre/Post-Test Interview Protocol (Implementation             150             180           29.91           5,384
 Team and Stakeholder Groups)...................
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/].

[[Page 45196]]

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. 2014-18297 Filed 8-1-14; 8:45 am]
BILLING CODE 4160-90-M
```