35038 Federal Register / Vol. 75, No. 118 / Monday, June 21, 2010 / Notices 

formulating, monitoring, and evaluating 

ASPR budgets and financial plans that 

support program activities and ensures 

the effective and efficient execution of 

ASPR financial resources. OFPA has 

administrative oversight of the 

Administration & Finance section of the 

emergency management group that is 

activated under ESF 8 of the NRF during 

a public health emergency. On behalf of 

the ASPR, OFPA serves as the primary 

point of contact with the Office of the 

Assistant Secretary for Financial 

Resources, the Office of Management 

and Budget (OMB) and Congressional 

Appropriation Committees. In 

compliance with OMB Circular A–123, 

FPA ensures accountability and 

effectiveness of ASPR’s financial 

programs and operations by 

establishing, assessing, correcting, and 

reporting on internal controls. 

The Office of Financial Planning and 

Analysis is headed by a Director and 

includes the following components: 

• Division of Budget Formulation and 

Execution (ANF1) 

• Division of Requisition Services 

(ANF2) 

• Division of Management Assurance 

(ANF3) 

• Division of Administration and 

Finance (ANF4) 

II. Delegations of Authority. All 

delegations and redelegations of 

authority made to officials and 

employees of affected organizational 

components will continue in them or 

their successors pending further 

redelegation, provided they are 

consistent with this reorganization. 

Dated: June 14, 2010. 

E.J. Holland, Jr., 

Assistant Secretary for Administration. 

[FR Doc. 2010–14997 Filed 6–18–10; 8:45 am] 

BILLING CODE 4150–37–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: 

‘‘Avoiding Readmissions in Hospitals 

Serving Diverse Patients.’’ 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 August 20, 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 

Avoiding Readmissions in Hospitals 

Serving Diverse Patients 

An important part of AHRQ’s mission 

is to disseminate information and tools 

that can support improvement in quality 

and safety in the U.S. health care 

community. The transition process from 

the hospital to the outpatient setting is 

nonstandardized and frequently 

inadequate in quality. One in five 

hospital discharges is complicated by an 

adverse event (AE) within 30 days, often 

leading to an emergency department 

visit and/or rehospitalization. Many 

readmissions stem from errors that can 

be directly attributed to the 

discontinuity and fragmentation of care 

at discharge. High rates of low health 

literacy, lack of coordination in the 

‘‘hand-off’ from the hospital to 

community care, gaps in social 

supports, and other limitations also 

contribute to the risk of 

rehospitalization. 

Boston University Medical Center 

(BUMC), through a grant from AHRQ, 

previously defined the discharge 

process and determined what 

improvements could be made to 

improve this care transition for patients. 

This new process was called the ‘‘reengineered discharge’’ (RED). The RED 

consists of 11 elements, including 

educating the patient throughout the 

hospital stay, making follow-up 

appointments, and giving the patient a 

written discharge plan. The RED was 

tested in a randomized controlled trial 

in an academic safety net hospital at 

BUMC with English speaking, general 

medical patients being discharged to 

home or community settings. Results of 

this trial of 749 patients showed a 

reduction in rehospitalizations within 

30 days and emergency department 

visits following hospital discharge. 

Participants also followed up with 

primary care providers more often and 

reported higher patient satisfaction with 

the discharge process. Project RED 

researchers created several tools to help 

hospitals replicate RED. After AHRQ 

and Project RED researchers fielded 

many inquiries about how to implement 

Project RED at hospitals nationwide, 

AHRQ realized that the Project RED 

Toolkit did not provide sufficient 

guidance to potential replicators. 

Various components of the RED were 

not documented, and issues regarding 

implementing the RED at hospitals 

serving linguistically and culturally 

diverse patient populations had not 

been addressed. AHRQ has therefore 

contracted with the RED researchers to 

create a revised RED Toolkit that will 

address these issues. 

This proposed information collection 

supports AHRQs mission by improving 

upon the RED Toolkit. This project has 

the following 3 goals: 

(1) To revise the Project RED Toolkit 

to comprehensively address all 

components of the RED, as well as the 

needs of culturally and linguistically 

diverse patients; 

(2) To pre-test the revised RED Toolkit 

in ten varied hospital settings, 

evaluating how the RED Toolkit is 

implemented in varied hospital settings 

by: (a) Documenting the implementation 

process; (b) assessing the fidelity of 

implementation; and (c) identifying the 

factors that affect redesign fidelity, 

including intensity of technical 

assistance (TA). 

(3) To modify the revised RED Toolkit 

based on pre-testing and to disseminate 

it. 

BUMC will provide TA at two varying 

levels. Four selected hospitals will 

receive ‘‘train-the-trainer’’ TA, which 

includes: 

(1) Telephone assistance in 

conducting a baseline needs assessment; 

(2) Master trainer training; 

(3) Access to Webinar trainings 

specifically designed for each user 

(nurse, IT professional, hospital 

leadership, and pharmacist); 

(4) An electronic template to print an 

After Hospital Care Plan (AHCP) 

booklet; and 

(5) E-mails regarding updates to the 

RED Web site and the opportunity to ask 

questions about the newly revised and 

enhanced RED tools and 

implementation via telephone and 

email. 

Six selected hospitals will receive 

intensive TA, which includes: 


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Federal Register / Vol. 75, No. 118 / Monday, June 21, 2010 / Notices 35039 

(1) Telephone baseline needs 

assessment; 

(2) On-site training; 

(3) Monthly semi-structured 

interviews via phone calls with the 

implementation team to discuss 

implementation efforts and barriers; 

(4) Adaptation of the revised RED 

Toolkit to include specific details about 

the hospital (such as the hospital name 

on the cover of the AHCP booklet and 

hospital-specific services provided to 

patients included in the AHCP booklet); 

(5) An assessment and evaluation site 

visit by the organizational change 

evaluator (a member of the 

implementation team), at baseline and 

12 months after the start of 

implementation efforts to interview 

select participating hospital staff; 

6) IT support to install and support 

the RED Toolkit software to 

automatically generate the AHCP 

booklet; and 

(7) E-mails regarding updates to the 

RED Web site and the opportunity to ask 

questions about the newly revised and 

enhanced RED tools and 

implementation via telephone and 

email. 

A diverse group of hospitals will be 

selected to receive each level of TA, 

based upon hospital size, location, 

readmission rate and patient 

population. Implementing the revised 

RED Toolkit in diverse settings will 

provide a better understanding of 

whether and how RED can be best 

implemented in different hospital 

settings. 

The project will be framed within a 

model of organizational change and 

transformation called the Organizational 

Transformation Model (OTM), which is 

based on the evaluation of Robert Wood 

Johnson Foundation’s Pursuing 

Perfection initiative. OTM identifies key 

elements that drive dramatic system 

change and informs the implementation 

process and impact evaluation. Using a 

mixed-methods design, the evaluation 

tracks change over time and across the 

implementation period within each 

hospital. The evaluation therefore will 

encompass feedback on specific 

implementation processes and factors in 

microsystems where RED is adopted, in 

the larger organizational context, and 

interactions between the two. 

This research study is being 

conducted by AHRQ through its 

contractor, BUMC, pursuant to AHRQ’s 

statutory authority to conduct and 

support research on healthcare and 

disseminate information 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. 299(b) and 299a(a)(1) and (2). 

Method of Collection 

To achieve the projects’ second and 

third goals, the following data 

collections and training will be 

implemented for the six hospitals that 

will receive more TA as well as the 4 

hospitals receiving train-the-trainer TA, 

unless otherwise noted: 

(1) Baseline needs assessment to help 

each hospital plan and prepare for 

implementation of the revised RED 

Toolkit and to evaluate it in varied 

settings. The baseline needs assessment 

will be administered by telephone, 

approximately two months prior to 

implementation, to the key contact at 

each of the ten study hospitals. The 

purpose of the assessment is to identify 

the implementation team, collect some 

basic information about the hospital, 

such as the number of beds and if 

electronic medical records are used, and 

to establish the baseline readmission 

rate. 

(2) Monthly semi-structured 

interviews with the key contact or other 

implementation team member will be 

conducted monthly for 12 months after 

implementation. These interviews will 

be conducted by phone with each of the 

six hospitals receiving intensive 

technical assistance (TA) (the two levels 

of TA are described above). The purpose 

of these interviews are to allow 

hospitals to share their experiences with 

implementing the revised RED Toolkit, 

their use of specific tools, changes 

resulting from using the tools and 

problems encountered implementing 

the revised RED Toolkit and how they 

are being addressed. 

(3) Baseline semi-structured 

interviews will be conducted prior to 

the implementation of the revised RED 

Toolkit with 15 hospital staff from each 

of the six study hospitals receiving 

intensive TA. The purpose of this 

interview is to measure the staffs 

opinion of the current discharge 

process, their perceived need for a 

redesigned process, and the perceived 

barriers and facilitators to redesigning 

the discharge process. 

(4) Post implementation semistructured interviews will be conducted 

12 months after the implementation of 

the revised RED Toolkit with 15 

hospital staff from each of the six study 

hospitals receiving intensive TA. The 

purpose of this interview is to measure 

the staffs opinion of the redesigned 

discharge process, which tools were 

used and their opinion of the tools, and 

the observed barriers and facilitators to 

redesigning the discharge process. 

(5) Patient surveys will be 

administered by telephone to a random 

sample of patients 30 days after being 

discharged from one of the six intensive 

TA study hospitals. The purpose of this 

survey is to measure patient outcomes, 

including satisfaction with the care they 

received, 30-day hospital and 

emergency department visits, and 

physician appointments, to help 

determine the success of the RED 

Toolkit implementation in diverse 

patient populations. The survey will be 

administered by a hospital staff member 

to patients during the preimplementation period and again during 

the post-implementation period to 

compare patient outcomes. 

(6) Medical record review of patient 

outcomes at all ten study hospitals. This 

data collection will be conducted both 

pre- and postimplementation of the 

revised RED Toolkit and will inform the 

success of the revised RED Toolkit 

implementation in diverse patient 

populations. Outcomes to be collected 

include process outcomes, such as 

primary care provider appointments 

scheduled prior to discharge, and 

patient outcomes, such as 30-day 

hospital and emergency department 

visits. 

(7) Master trainer training will be 

conducted with 3 staff members from 

each of the 4 hospitals receiving trainthe-trainer TA. These people will be 

trained to administer the RED Toolkit 

and be able to use recorded Webinar 

training sessions within their 

organization. They will be invited to 

travel to BUMC for a 2-day onsite 

orientation of the RED intervention. 

These people will meet with several 

members of the BUMC implementation 

team (physician leader, discharge 

advocate nurse) and will have the 

opportunity to shadow the nurse 

discharge advocates in conducting the 

RED intervention. 

(8) Intensive training will be 

conducted with about 28 staff from each 

of the 6 hospitals receiving intensive 

TA. The training will consist of a twoday on-site orientation and training at 

each hospital conducted by the BUMC 

implementation team. The BUMC 

implementation team will consist of a 

physician researcher, a discharge 

advocate nurse, an organizational 

change champion/evaluator and the 

information technology expert. The 

BUMC team will spend two days, 8 

hours per day, to train the relevant 

hospital staff to perform the 11 

components of the RED discharge. The 

training will include material for senior 

hospital management, hospital 

physicians, nurses, IT staff, and 

pharmacists. 


sroberts on DSKD5P82C1PROD with NOTICES
35040 Federal Register / Vol. 75, No. 118 / Monday, June 21, 2010 / Notices 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden hours associated 

with the respondent’s time to 

participate in this research. The baseline 

needs assessment will be administered 

to the key contact at each of the 10 

participating hospitals and takes about 2 

hours to complete. Monthly semistructured interviews with the key 

contact or other implementation team 

member will be conducted monthly for 

12 months after implementation. These 

interviews will be conducted by phone 

with each of the six hospitals receiving 

intensive TA and will require 1 hour to 

complete. Both the base-line and postimplementation semi-structured 

interviews will be conducted with 15 

staff members from each of the 6 

hospitals receiving intensive TA and 

will last about one hour. The patient 

survey will be administered twice, pre 

and post implementation, to 3,108 

patients recently discharged from one of 

the 6 hospitals receiving intensive TA 

and requires 10 minutes to complete. 

Medical record review will be 

performed at all 10 participating 

hospitals both pre- and postimplementation and will take about 41.6 

hours. Master trainer training will be 

conducted with 3 staff members from 

each of the 4 hospitals receiving train 

the trainer TA and will last 16 hours. 

Intensive training will be conducted 

with about 28 staff members from each 

of the 6 hospitals receiving intensive TA 

and will also last 16 hours. The total 

annualized burden is estimated to be 

5,020 hours. 

Exhibit 2 shows the estimated 

annualized cost burden associated with 

the respondent’s time to participate in 

this research. The total annualized cost 

burden is estimated to be $162,157. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Baseline needs assessment ............................................................................ 10 1 2 20 

Monthly semi-structured interviews ................................................................. 6 12 1 72 

Base-line semi-structured interview ................................................................. 6 15 1 90 

Post implementation semi-structured interview ............................................... 6 15 1 90 

Patient survey .................................................................................................. 3,108 2 10/60 1,036 

Medical record review ...................................................................................... 10 2 41.6 832 

Master trainer training ...................................................................................... 4 3 16 192 

Intensive training .............................................................................................. 6 28 16 2,688 

Total .......................................................................................................... 3,156 na na 5,020 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Form name Number of 

respondents 

Total burden 

hours 

Average 

hourly wage 

rate* 

Total cost 

burden 

Baseline needs assessment ............................................................................ 10 20 a $41.94 $839 

Monthly semi-structured interviews ................................................................. 6 72 b 40.91 2,946 

Base-line semi-structured interview ................................................................. 6 90 c 38.51 3,466 

Post implementation semi-structured interview ............................................... 6 90 d 38.51 3,466 

Patient survey .................................................................................................. 3,108 1,036 20.32 21,052 

Medical record review ...................................................................................... 10 832 17.32 14,410 

Master trainer training ...................................................................................... 4 192 g 31.31 6,012 

Intensive training .............................................................................................. 6 2,688 h 40.91 109,966 

Total .......................................................................................................... 3,156 5,020 na 162,157 

* Based upon the mean of the average wages, National Compensation Survey: Occupational wages in the United States May 2008, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’ a 75% Nurses (29–1111, $31.31/hr), 20% Physicians (29–1069, $79.33/hr) and 5% General and Operations Managers (29–1069, $51.91/hr); b 80% Nurses and 20% Physicians; c and d 85% Nurses and 15% Physicians; e 100% General public (00–0000, $20.32/hr); f 100% Statistical assistants (43–9111, $17.32/hr); g 100% Nurses; h 80% Nurses and 20% Physicians. 

Estimated Annual Costs to the Federal 

Government 

Exhibit 3 shows the total and 

annualized cost over the 18 months of 

this clearance. The total cost is 

$449,976. 

EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST

Cost component Total cost Annual cost 

Project RED Toolkit Development ............................................................................................................... $97,413 $64,942 

Dissemination Planning and Support .......................................................................................................... 98,080 65,387 

Data Collection Activities ............................................................................................................................. 84,563 56,375 

Data Processing and Analysis ..................................................................................................................... 52,215 34,810 

Publication of Results .................................................................................................................................. 3,184 2,123 

Project Management .................................................................................................................................... 28,892 19,261 


sroberts on DSKD5P82C1PROD with NOTICES
Federal Register / Vol. 75, No. 118 / Monday, June 21, 2010 / Notices 35041 

EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST—Continued 

Cost component Total cost Annual cost 

Overhead ..................................................................................................................................................... 85,629 57,086 

Total ...................................................................................................................................................... 449,976 299,984 

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 

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: June 8, 2010. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2010–14864 Filed 6–18–10; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[60-Day–10–10EG] 

Proposed Data Collections Submitted 

for Public Comment and 

Recommendations 

In compliance with the requirement 

of Section 3506(c)(2)(A) of the 

Paperwork Reduction Act of 1995 for 

opportunity for public comment on 

proposed data collection projects, the 

Centers for Disease Control and 

Prevention (CDC) will publish periodic 

summaries of proposed projects. To 

request more information on the 

proposed projects or to obtain a copy of 

the data collection plans and 

instruments, call 404–639–5960 and 

send comments to Maryam I. Daneshvar, 

CDC Acting Reports Clearance Officer, 

1600 Clifton Road, MS–D74, Atlanta, 

GA 30333 or send an e-mail to 

omb@cdc.gov. 

Comments are invited on: (a) Whether 

the proposed collection of information 

is necessary for the proper performance 

of the functions of the agency, including 

whether the information shall have 

practical utility; (b) the accuracy of the 

agency’s estimate of the burden of the 

proposed collection 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 

on respondents, including through the 

use of automated collection techniques 

or other forms of information 

technology. Written comments should 

be received within 60 days of this 

notice. 

Proposed Project 

Audience Analysis for 

Biomonitoring—New—National Center 

for Environmental Health/Agency for 

Toxic Substances and Disease Registry 

(NCEH/ATSDR), Centers for Disease 

Control and Prevention (CDC). 

Background and Brief Description 

People’s exposure to environmental 

chemicals can be a risk to their health. 

Scientists at the CDC use biomonitoring, 

which is the measurement of 

environmental chemicals in human 

tissues and fluids, to assess such 

exposure. Biomonitoring findings, 

however, do not typically provide 

information on health risks and toxicity 

data often lag behind new 

biomonitoring data. The health effects 

on humans are, therefore, often 

uncertain or unknown, particularly, for 

many new or ‘‘emerging’’ chemicals. 

Nevertheless, communicating 

biomonitoring findings for those 

charged with this task is necessary, 

especially due to the growing media 

coverage and public concern about 

chemicals found in the human body. 

The demand for answers and decreasing 

patience with uncertainty characterizes 

the interpretation of such results. This 

poses enormous challenges to those 

tasked to communicate such findings to 

both scientific and non-scientific 

audiences without a biomonitoring 

background. 

The CDC is, therefore, interested in 

developing a framework for 

communicating health risk messages, 

particularly about emerging 

environmental chemicals, to the 

attentive public audience such as 

selected women who are pregnant or 

have very young children. The three 

environmental chemicals, Bisphenol A 

(BPA), phthalates, and mercury have 

been selected for this study. They are of 

particular interest to these selected 

women as the risks of exposure are 

higher for very young children because 

of their hand-to-mouth behaviors and 

direct oral (mouth) contact with 

materials containing these chemicals. 

Furthermore, young children eat and 

drink more per pound of body weight 

than adults. 

Focus groups will be conducted in 

different parts of the country with 

selected women. During phase one, 

eight exploratory focus groups will be 

conducted to develop messaging 

strategies and the results will be used in 

the development of preliminary 

messages about the emerging chemicals. 

The second phase will include six 

message testing focus groups to 

determine which messages are most 

attractive and compelling in terms of 

communicating health risk information 

about emerging chemicals. 

Participants will be recruited via 

standard focus group recruitment 

methods. Most will come from an 

existing database (or list) of potential 

participants maintained by the focus 

group facility. There is no cost to 

respondents. 


sroberts on DSKD5P82C1PROD with NOTICES