Federal Register / Vol. 78, No. 166 / Tuesday, August 27, 2013 / Notices 52925 

Strategic Communication, headed by the 

Division Director, is responsible for 

professional and public outreach, 

communications channel technical 

support, and regional liaison. The 

division develops and executes 

programs to educate the public and 

health professionals and conducts 

regional liaison activities; develops 

evidence-based approaches in the 

development and evaluation of 

educational materials and implements 

clinical professional and adult 

educational practices and 

methodologies; acts as the liaison with 

the OASH communications office; is the 

gatekeeper for all materials; and 

manages the clearance process for OWH 

communications. The division provides 

communications channel technical 

support by implementing a wide range 

of communications media (including 

listservs, print, radio, TV, and social 

media) and tools; oversees web design, 

content development, and management; 

acts as the OWH technical liaison and 

APSA web council representative; and 

maintains a social media presence. As 

the RHC liaison, it supports the RHC in 

their mission to coordinate and 

implement public health initiatives to 

promote women’s health issues at the 

regional, state, and local levels. 

D. Under Section AC.20, Functions, 

‘‘B. Office on Women’s Health (ACB)’’ 

following Section 3 Division of Strategic 

Communication (ACB3) insert: 

4. Division of Program Innovation 

(ACB4). The Division of Program 

Innovation, headed by the Division 

Director, is responsible for program 

development, management and support, 

and program development research. The 

division identifies evidence based 

strategies and develops model programs 

for targeted issues; designs, develops 

and implements interventions to 

improve women’s health; incorporates 

gender specific issues into model 

programs; provides oversight for model 

program development and all related 

activities, including budget 

development and management; 

identifies future direction of women’s 

health and associated strategies and 

gaps in current coverage; and reviews 

promising strategies to identify and 

promote innovative ideas for future 

program development. 

II. Delegations of Authority. Directives 

or orders made by the Secretary, 

Assistant Secretary for Health, or 

Director, Office on Women’s Health, all 

delegations and re-delegations of 

authority made to officials and 

employees of the affected organizational 

component will continue in force 

pending further redelegations, provided 

they are consistent with this 

reorganization. 

III. Funds, Personnel, and Equipment. 

Transfer of organizations and functions 

affected by this reorganization shall be 

accompanied by direct and support 

funds, positions, personnel, records, 

equipment, supplies, and other 

resources. 

Dated: August 15, 2013. 

E.J. Holland, Jr., 

Assistant Secretary for Administration. 

[FR Doc. 2013–20524 Filed 8–26–13; 8:45 am] 

BILLING CODE 4150–33–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: ‘‘Pilot 

Test of an Emergency Department 

Discharge Tool.’’ In accordance with the 

Paperwork Reduction Act of 1995, 44 

U.S.C. 3506(c)(2)(A), AHRQ invites the 

public to comment on this proposed 

information collection. 

DATES: Comments on this notice must be 

received by October 28, 2013. 

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 

Pilot Test of an Emergency Department 

Discharge Tool 

The research study ‘‘Pilot Test of an 

Emergency Discharge Tool’’ fully 

supports AHRQ’s mission. The ultimate 

aim of this study is to pilot test a 

discharge tool which has the potential 

to reduce unnecessary visits to the 

Emergency Department (ED), reduce 

healthcare expenditure in the ED, as 

well as streamline and enhance the 

quality of care delivered to ED patients. 

The ED is an important and frequently 

used setting of care for a large part of the 

U.S. population. In 2006, there were 

nearly 120 million ED visits in the U.S., 

of which only 15.5 million (14.7%) 

resulted in admission to the hospital or 

transfer to another hospital. Thus the 

majority ED visits result in discharge to 

home. Patients discharged from the ED 

face significant risk for adverse 

outcomes, with between 3–5 patients 

per 100,000 visits experiencing an 

unexpected death following discharge 

from the ED. Additionally, a sizable 

minority of patients return to the ED 

frequently. Published studies estimate 

that 4.5% to 8% of patients revisit the 

ED 4 or more times per year, accounting 

for 21% to 28% of all ED visits. Internal 

data from John Hopkins Hospital, 

AHRQ’s contractor for this pilot test, 

supports these findings with 7% of their 

patients accounting for 26% of visits to 

the Johns Hopkins Hospital ED in 2011. 

Patients who revisit the ED contribute 

to overcrowding, unnecessary delays in 

care, dissatisfaction, and avoidable 

patient harm. ED revisits are also an 

important contributor to rising health 

care costs, as ED care is estimated to 

cost two to five times as much as the 

same treatment delivered by a primary 

care physician. Thus it is estimated that 

eliminating revisits and inappropriate 

use of EDs could reduce health care 

spending as much as $32 billion each 

year. Overall, an effective and efficient 

ED discharge process would improve 

the quality of patient care in the ED as 

well as reduce healthcare costs. 

To respond to the challenges faced by 

our nation’s EDs and the patients they 

serve, AHRQ will develop and pilot test 

a tool to improve the ED discharge 

process. More specifically, this project 

has the following goals: 

(1) Develop and Pilot Test a Prototype 

ED Discharge Tool in a limited 

number of settings to assess: 

(A) The feasibility for use with 

patients; 

(B) The methodological and resource 

requirements associated with tool use; 

(C) The feasibility of measuring 

outcomes; 

(D) The costs of implementation and; 

(E) Treliminary outcomes or impacts 

of tool use. 

(2) Revise the Tool based on the 

results from the Pilot Test 

This study is being conducted by 

AHRQ through its contractor, John 

Hopkins Hospital, pursuant to AHRQ’s 

statutory authority to conduct and 

support research on healthcare and on 


tkelley on DSK3SPTVN1PROD with NOTICES
52926 Federal Register / Vol. 78, No. 166 / Tuesday, August 27, 2013 / Notices 

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 

To achieve these goals the following 

data collections will be implemented: 

(1) Emergency Department Discharge 

Tool (EDT)—The EDT will be pilot 

tested in the three John Hopkins EDs in 

Baltimore. The purpose of the EDT is to 

assist hospitals in identifying patients 

who excessively use the ED and can be 

categorized as ‘‘frequent ED users,’’ and 

to target interventions to these patients 

to reduce the risk of further avoidable 

revisits. A designated ED personnel will 

screen the medical record of all adult 

patients for the presence of frequent ED 

use, the key risk factor for ED discharge 

failure. Frequent ED use is defined as: 

(1) 1 or more previous ED visit within 

the last 72-hours, or (2) 2 or more 

previous ED visits within the last 3 

months, or (3) 3 or more ED visits 

within the last 12 months. This 

definition can be modified to align with 

the resources of the individual ED. 

For those flagged as frequent ED users 

this tool uses data collected from the 

patient’s record and from the patient 

himself to identify individuals with risk 

factors that have been shown in the 

literature to predict sub-optimal ED 

discharges and resulting revisits. These 

risk factors include patients who are 

uninsured, lack a primary care 

physician, have psychiatric diseases, are 

substance users, have difficulty caring 

for themselves, or have trouble 

comprehending ED discharge 

instructions. 

A user’s manual (EDT User’s Manual) 

is also provided to assist EDs in 

developing resources to provide 

interventions recommended by the EDT. 

No data collection activities will be 

made from this manual. 

(2) One Month Patient Follow-up— 

After the ED visit, a project research 

assistant (RA) will have a follow-up 

telephone interview with all enrolled 

patients. During the interview, the RA 

will inquire about the patient’s 

remembrance of the instructions that 

were given for the patient. 

(3) Three Month Patient Follow-up— 

Patients who are uninsured will receive 

an additional phone call 3 months after 

the ED visit to assess whether or not 

they were able to acquire insurance. 

(4) Post Pilot Test Focus Groups— 

AHRQ will conduct three sets of focus 

groups to collect qualitative data about 

the usability and usefulness of the EDT 

from three stakeholder groups: EDT 

implementers, patients, and post-ED 

care providers. Questions for each of the 

focus groups will vary based on their 

differing objectives: 

(A) EDT Implementers Focus Group— 

For implementers of the EDT (RNs, case 

managers, social workers, research 

assistants), the objectives will include: 

(1) How well it does or does not meet 

implementer goals of discharge; (2) 

resources required for implementation; 

and (3) unintended consequences or 

impacts on other ED operations. 

(B) Patient Focus Group—For the 

patients, the objective will be: (1) What 

was their general impression of the EDT; 

(2) did the EDT improve the ED 

discharge process for them; and (3) do 

they foresee any potential unintended 

problems of the EDT. 

(C) Post-ED Care Providers Focus 

Group—For the post-ED care providers, 

the objectives are to determine: (1) How 

well the EDT has met the needs of these 

providers in caring for these patients; (2) 

how feasible it has been to properly care 

for patients for whom the EDT had been 

implemented; (3) if there are any 

unintended consequences of using the 

EDT. Post-ED care provider focus group 

members will be drawn from Johns 

Hopkins Community Physicians, EastBaltimore Medical Center (a primary 

referral site for patients without primary 

care), and Healthcare for the Homeless, 

a not-for-profit organization in 

Baltimore, Maryland that provides 

health services, education and advocacy 

to people affected by homelessness. 

(5) Post Pilot Test In-depth 

Interviews—AHRQ will conduct semistructured interviews with 

approximately eight individuals from 

each of the 3 stakeholder groups: EDT 

implementers, patients, and post-ED 

care providers. These individuals will 

provide feedback on issues surfaced 

during the focus groups. This will 

provide an opportunity to delve more 

deeply into specific topics of interest. 

(6) Administrative and Observational 

Data—Quantitative outcome measures 

will come from an extraction of medical 

record data and direct observations 

performed by project RAs. Data will be 

extracted from hospital billing records 

and Electronic Medical Records (EMRs) 

and will include frequency of revisits, 

cost of 72-hour returns, cost of ED visits 

per 3 months and the cost of 

implementing the EDT. To calculate 

costs of program implementation, RAs 

will observe the time required by social 

work, case management, and nursing 

staff to implement the interventions 

prescribed in the tool. They will also 

keep a log of the materials given to the 

patients as part of the intervention. To 

evaluate the percentage of patients 

evaluated for assistance or placement, 

RAs will observe case managers/social 

workers during their interaction with 

the patients. To evaluate the percentage 

of follow-up phone calls, the RAs will 

keep a log of attempts and actual 

contacts. Since these data collections 

involve RA observations, or extractions 

from existing medical records 

performed by the RA, they pose no 

burden to the hospital or public and 

therefore are not included in the burden 

estimates in Exhibit 1. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden for the respondents’ 

time to participate in this pilot test. The 

EDT will be pilot tested with a total of 

1,200 patients (50 per week * 8 weeks 

* 3 sites = 1,200) and takes about 20 

minutes per patient to complete. The 

one-month patient follow-up will be 

conducted with all 1,200 patients and 

will take 10 minutes to complete. The 

3-month patient follow-up will be 

conducted with those patients identified 

as being uninsured and is estimated to 

take 5 minutes to complete. 

Focus groups will be conducted with 

all three of the stakeholder groups (EDT 

implementers, patients, and post-ED 

care providers). There will be two 

groups held for the EDT implementers 

consisting of 8 persons each (16 total), 

and one group of 8 for both the patients 

and the post-ED care providers. Each 

focus group will last for 2 hours. 

As a follow-up to the focus groups indepth interviews will be conducted 

with eight members from each of the 

three stakeholder groups. The 

interviews will require one hour to 

complete. The total annualized burden 

is estimated to be 708 hours. 

Exhibit 2 shows the annualized cost 

burden associated with the respondents’ 

time to participate in the pilot test. The 

total annualized cost burden is 

estimated to be $16,359. 


tkelley on DSK3SPTVN1PROD with NOTICES
Federal Register / Vol. 78, No. 166 / Tuesday, August 27, 2013 / Notices 52927 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

respondents 

Number of 

responses 

per 

respondent 

Hours per 

response 

Total 

burden 

hours 

Pilot Test of the Emergency Department Discharge Tool (EDT) 

EDT .......................................................................................................................... 1,200 1 20/60 400 

One Month Patient Follow-up .................................................................................. 1,200 1 10/60 200 

Three Month Patient Follow-up ............................................................................... 240 1 5/60 20 

Post Pilot Test Focus Groups and Interviews 

EDT Implementers Focus Group ............................................................................. 16 1 2 32 

Patient Focus Group ................................................................................................ 8 1 2 16 

Post-ED Care Providers Focus Group .................................................................... 8 1 2 16 

EDT Implementer Interview ..................................................................................... 8 1 1 8 

Patient Interview ...................................................................................................... 8 1 1 8 

Post-ED Care Providers Interview ........................................................................... 8 1 1 8 

Total .................................................................................................................. 2,696 na na 708 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Form name Number of 

respondents 

Total 

burden hours 

Average 

hourly wage 

rate*

Total cost 

burden hours 

Pilot Test of the Emergency Department Discharge Tool (EDT) 

EDT .......................................................................................................................... 1,200 400 $22.01a $8,804 

One Month Patient Follow-up .................................................................................. 1,200 200 22.01a 4,402 

Three Month Patient Follow-up ............................................................................... 240 20 22.01a 440 

Post Pilot Test Focus Groups and Interviews 

EDT Implementers Focus Group ............................................................................. 16 32 27.42b 877 

Patient Focus Group ................................................................................................ 8 16 22.01a 352 

Post-ED Care Providers Focus Group .................................................................... 8 16 45.36c 726 

EDT Implementer Interview ..................................................................................... 8 8 27.42b 219 

Patient Interview ...................................................................................................... 8 8 22.01a 176 

Post-ED Care Providers Interview ........................................................................... 8 8 45.36c 363 

Total .................................................................................................................. 2,696 708 na 16,359 

*

National Compensation Survey: Occupational wages in the United States May 2012, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’ a—based on the mean wages for All Occupations (00–0000) 

b—salary based upon average of: 2 nurses (29–1141), 2 case managers (29–1141), 2 social workers (21–1022), and 2 research assistants 

(19–4061) c—salary based upon average of: 2 physicians (29–1060), 2 nurses (29–1141), 2 case managers (29–1141), 2 social workers (21–1022). 

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 health care research, quality 

improvement and 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: August 8, 2013. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2013–20825 Filed 8–26–13; 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: 

‘‘Assessing the Impact of the National 


tkelley on DSK3SPTVN1PROD with NOTICES