### 69674 Federal Register / Vol. 75, No. 219 / Monday, November 15, 2010 / Notices

Secure Communication Network (Epi– X) OMB Control No. 0920–0636. During this revision, we are requesting the title be revised to read—Centers for Disease Control and Prevention (CDC) Secure Communications Network (Epi–X).

This IC is also being revised to improve the effectiveness of CDC communications with its public health partners during public health incident responses. Improvements include the addition of new data collection instruments related to six specific public health incidents. The addition of these instruments and the associated increase in burden hours is required to ensure that CDC and other Federal agencies will have secure, timely, and accurate information from our public health partners. This information is required by CDC during a public health incident for decision making and for effective and efficient execution of CDC’s response activities. Public health partners include public health officials and agencies at the state and local level.

From 2005–2009, CDC conducted incident specific, public health emergency response operations on average of four public health incidents a year with an average emergency response length of 48 days for each incident. The effectiveness and efficiency of CDC’s response to any public health incident depends on information at the agency’s disposal to characterize and monitor the incident, make timely decisions, and take appropriate actions to prevent or reduce the impact of the incident. Available information during many public health incident responses is often incomplete, is not easily validated by state and local health authorities, and is sometimes conflicting. This lack of reliable information often creates a high level of uncertainty with potential negative impacts on public health response operations.

Secure communications with CDC’s state and local public health partners is essential to de-conflict information, validate incident status, and establish and maintain accurate situation awareness. Reliable, secure communications are essential for the agency to, make informed decisions, and to respond in the most appropriate manner possible in order to minimize the impact of an incident on the public health of the United States.

Epi–X is CDC’s Web-based communication system for securely communicating during public healthemergencies that have multijurisdictional impact and implications. Epi–X was specifically designed to provide public health decision-makers at the state and local levels a secure, reliable tool for communicating information about sensitive, unusual, or urgent public health incidents to neighboring jurisdictions as well as to CDC. The system was also designed to generate a request for epidemiologic assistance (Epi–Aid) from CDC using a secure, paperless environment.

Epi–X designers have developed functionalities that permit targeting of critical outbreak information to specific public health authorities who can act quickly to prevent the spread of diseasesand other emergencies in multijurisdictional settings, such as those that could occur during an influenza pandemic, infection of food and water resources, and natural disasters.

CDC has recognized a need to expand the use of Epi–X to collect specific response related information during public health emergencies. Authorized Officials from state and local health departments impacted by the public health incident will be surveyed only by Epi–X. Respondents will be informed of this data collection first through an Epi–
X Facilitator, who will work closely with Epi–X program staff to ensure that Epi–X incident specific IC is understood. The survey instruments will contain specific questions relevant to the current and ongoing public health incident and response activities.

The Web-based tool for data collection under Epi–X already is established for the current IC and has been in use since 2003. CDC will adapt it as needed to accommodate the data collection instruments. Respondents will receive the survey instrument as an official CDC e-mail, which is clearly labeled, ‘‘Epi–X Emergency Public Health Incident Information Request. ’’ The e-mail message will be accompanied by a link to an Epi–X
Forum discussion web page. Respondents can provide their answers to the survey questions by posting information within the discussion.

There are no costs to respondents except their time. The total estimated annual burden hours are 24,400.



### E STIMATED 

### A NNUALIZED 

### B URDEN 

### H OURS

Type of respondent No. of respondents No. of
responses per

respondent Average burden per response (in hours)

State epidemiologists ..........................................................................................................

......... 50 104 1 City and county health officials ............................................................................................... ..... 1600 12 1

Dated: November 4, 2010.
Carol Walker, Acting Reports Clearance Officer, Centers for
Disease Control and Prevention.

[FR Doc. 2010–28577 Filed 11–12–10; 8:45 am]

**BILLING CODE 4163–18–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:

‘‘Development of the Guide to Patient and Family Engagement in Health Care Quality and Safety in the Hospital Setting. ’’ 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 January 14, 2011.

**ADDRESSES :**  Written comments should be submitted to: Doris Lefkowitz,


### 69675 Federal Register / Vol. 75, No. 219 / Monday, November 15, 2010 / Notices

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
Development of the Guide to Patient and Family Engagement in Health Care Quality and Safety in the Hospital Setting

Improving the quality and safety of health care in the United States is one of the most significant challenges facing the American health care system. Too many Americans continue to receive health care that is not grounded in a reliable evidence base of what is proven appropriate, safe, and effective. Extensive studies conducted during recent decades demonstrate that the U.S. health care system provides continuing unwarranted variation and costly, inefficient, and simply unsafe care. Involving patients and families in improving quality and safety in hospitals has the potential to improve health care experiences, delivery, and outcomes. AHRQ has been at the forefront of supporting increased involvement for patients, families, and the public in all aspects of health care.

This project will develop a program to help patients, families, and health professionals in the hospital support one another to improve quality and safety. To accomplish these goals, patients and families must be able to express what they want from their hospital care and how they want to be involved and then effectively communicate this information with health professionals. Conversely, health professionals must be able to understand what patients want to do and what is appropriate for them to do and feel that they have the system supports and tools to facilitate these
actions.

To address this issue and help fulfill AHRQ’s mission of health care quality improvement, AHRQ will develop a set of interventions and materials, entitled the Guide to Patient and Family Engagement in Health Care Quality and Safety in the Hospital Setting (‘‘the Guide’’), for use by patients, their family members, health care professionals, and hospital leaders to foster patient and family engagement around the issues of hospital safety and quality.

The goals of this project are to: (1) Identify the barriers and facilitators to implementing the Guide, including how barriers were overcome;

(2) Assess staff satisfaction with the Guide and change in staff behavior before and after implementation of the Guide including organizational culture with respect to patient- and familyengagement and patient- and familycentered care;

(3) Assess patient satisfaction with the Guide and change in patient experience of care before and after implementation of the Guide including patient/family involvement in their own health care and patient/family involvement in quality improvement and patient safety activities; and

(4) Refine the Guide as necessary to improve implementation and effectiveness.

The Guide will be tested in three hospitals which will vary in terms of size, location, teaching status, and ownership.

This study is being conducted by AHRQ through its contractor, the American Institutes for Research (AIR), pursuant to AHRQ’s statutory authority to promote health care quality improvement by conducting and supporting research that develops and presents scientific evidence regarding all aspects of health care, including the development and assessment of methods for enhancing patient participation in their own care and for facilitating shared patient-physician decision-making. 42 U.S.C. 299(b)(1)(A).

Method of Collection

To achieve the goals of this project the following data collections will be implemented:

(1) Semi-structured interviews will be conducted in-person with hospital staff and hospital leaders from each of the participating health care facilities. Both pre- and postimplementation interviews will be conducted and separate interview guides will be used for staff and leaders. Pre-implementation, the interviews will focus on current knowledge, attitudes and beliefs around patient and family engagement and on the current organizational culture and climate surrounding patient and family engagement. Post-implementation, interviews will be conducted to understand the hospital’s experiences implementing the Guide interventions, including how easy or difficult the Guide was to implement; the perceived effects of the Guide implementation; and the sustainability of the Guide
interventions. (2) Collection of documentation from each participating facility. The purpose of this collection of documentation is to gather documentation of the implementation of the Guide and to document policies and procedures related to patient and family engagement through a review of records and other materials. To the extent that it is available, the following types of documentation will be collected:

Æ Background on organizational structure and vision.

Æ Policies and procedures related to Component 1 and Component 2 strategies of the Guide.

Æ Tools used to foster communication between patients, family members and health care team.

Æ Policies and procedures related topatient and family engagement, patientand family-centered care, quality and safety.

This task will consist of forwarding emails and or photocopying and sending documents to the project team both pre- and post-implementation.

(3) Bi-weekly semi-structured interviews will be conducted by telephone with the implementation coordinators from each participating facility. At each hospital site, an implementation coordinator will be responsible for overseeing implementation activities and serving as a primary point-of-contact. Interviews with these individuals will provide a complete understanding of the Guide implementation and the ability to track the implementation in real time. These interviews will occur bi-weekly for 9 months.

(4) Observation of Guide implementation around different activities targeted in the Guide components. The purpose of these observations is to directly assess how the Guide is being implemented and to determine which follow up questions from the semi-structured interview protocol should be prioritized orremoved during the in-person semistructured interviews. As such,observations will occur postimplementation only. Observations will be conducted by the project staff so this data collection does not impose a burden on the participating hospitals; therefore it is not included in Exhibit 1.

(5) Focus groups with patients and family members at each of the participating sites. The purpose of these groups is to elicit information about patients’ and families’ experiences of care at the hospital along with their reactions to tools in the Guide and their implementation. Three focus groups of up to 8 individuals will be conducted at each hospital post implementation. One


### 69676 Federal Register / Vol. 75, No. 219 / Monday, November 15, 2010 / Notices

focus group will be conducted with patients only, one with family members only and one with patients and family members together.

(6) Staff Survey with hospital staff.The purpose of the pre- and postimplementation Staff Survey is to assess changes in organizational culture related to patient safety and engagement, and to assess significant changes in staff knowledge, attitudes, and behaviors. Items from the Medical College of Georgia (MCG) Patient- and Family-Centered Care Culture Survey will be used in this data collection activity. The survey items will be supplemented with questions from AHRQ’s Hospital Survey on Patient Safety Culture (HSOPS) and from the Army Medical Department Climate Survey. At each of the three hospital sites, it is estimated that survey responses will be collected from at least 50 health professionals. The same questionnaire will be used at pre- and post-implementation.

(7) Patient Survey. The patient surveywhich will be administered preimplementation and again at postimplementation will be built around the
CAHPS ® Hospital Survey (HCAHPS) domains that assess aspects of patientphysician interaction around the hospital stay, including Communication with Nurses, Communication with Doctors, Communication about Medicines, Responsiveness of Hospital Staff, and Discharge Information. These scales directly assess the aspects of the hospital stay and encounters that we are hoping the Guide will affect. Additional questions to address any aspects of care covered by the Guide that are not adequately addressed by the HCAHPS composites will also be included in this survey. Additionally, measures from the Patient Activation Measures (PAM) Survey will also be included. The same questionnaire will be used pre- and post-implementation.
Estimated Annual Respondent Burden

Exhibit 1 shows the estimated burden hours for the respondents’ time toparticipate in this project. Semistructured interviews will be conducted with about 4 hospital staff members both pre- and post-implementation andrequires one hour to complete. Semistructured interviews will also beconducted with 2 hospital leaders, preand post-implementation, and will take one hour to complete. Collection of documentation will occur twice at each hospital and requires 4 hours to complete. Bi-weekly semi-structured interviews will be conducted with the implementation coordinator at each hospital. A total of 18 interviews per hospital over a 9 month period will occur with each interview taking about 30 minutes. Focus groups will take place separately with patients, their families, and both patients and their families and will last for about an hour and a half. The staff survey will be completed by approximately SO hospital staff members from each hospital, pre- and post-implementation, and requires 15 minutes to complete. The patient survey will be conducted twice, pre- and post-implementation, by about 884 patients across all 3 participating hospitals and will take 30 minutes to complete. The total annualized burden hours are estimated to be 1,190 hours.

Exhibit 2 shows the estimated annualized cost burden associated with the respondents’ time to participate in this project. The total cost burden is estimated to be $27,316.



### EXHIBIT 

### 1—E STIMATED 

### A NNUALIZED 

### B URDEN 

### H OURS

Data collection activity Number of respondents Number of responses per respondent Hours per response Total burden hours

Semi-structured leader interviews—pre-implementation ................................. 3 4 1 12 Semi-structured leader interviews—post-implementation ............................... 3 4 1 12 Semi-structured staff interviews—pre-implementation .................................... 3 8 1 24 Semi-structured staff interviews—pre-implementation .................................... 3 8 1 24
Collection of documentation ............................................................................ 3 2 4 24 Bi-weekly semi-structured interviews ............................................................... 3 18 30/60 27 Focus group with patients ............................................................................... 24 1 90/60 36 Focus group with patients’ family .................................................................... 24 1 90/60 36 Focus group with patients & family ................................................................. 24 1 90/60 36 Staff survey ...................................................................................................... 3 100 15/60 75 Patient survey .................................................................................................. 884 2 30/60 884

Total .......................................................................................................... 977 na na 1,190



### EXHIBIT 

### 2—E STIMATED 

### A NNUALIZED 

### C OST 

### B URDEN

Form name Number of respondents Total burden hours Average hourly wage rate* Total cost burden

Semi-structured leader interviews—pre-implementation ................................. 3 12 $43.74 $525 Semi-structured leader interviews—post-implementation ............................... 3 12 43.74 525 Semi-structured staff interviews—pre-implementation .................................... 3 24 33.51 804 Semi-structured staff interviews—post-implementation ................................... 3 24 33.51 804
Collection of documentation ............................................................................ 3 24 21.16 508 Bi-weekly semi-structured interviews ............................................................... 3 27 33.51 905 Focus group with patients ............................................................................... 24 36 20.90 752 Focus group with patients’ family .................................................................... 24 36 20.90 752 Focus group with patients & family ................................................................. 24 36 20.90 752 Staff survey ...................................................................................................... 3 75 33.51 2, 513 Patient survey—pre-implementation ................................................................ 884 884 20.90 18,476


### 69677 Federal Register / Vol. 75, No. 219 / Monday, November 15, 2010 / Notices

EXHIBIT 

### 2—E STIMATED 

### A NNUALIZED 

### C OST 

### B URDEN

### —Continued

Form name Number of respondents Total burden hours Average hourly wage rate* Total cost burden

Total .......................................................................................................... 977 1,190 n/a 27 ,316

* Based upon the mean of the wages for 11–9111 Medical & Health Services Manager ($43.74), 29–000 Healthcare Practitioner and Technical Occupations ($33.51), 43–6011 Executive Secretaries and Administrative Assistants ($21.16) and 00–0000 All Occupations ($20.90), May 2009 National Occupational Employment and Wage Estimates. United States, ‘‘ U.S. Department of Labor, Bureau of Labor Statistics. ’’ http:// www.bls.gov/oes/current/oes

_nat.htm#b29–0000.

Estimated Annual Costs to the Federal
Government

Exhibit 3 below breaks down the costs related to this study. Since this study will span two years, the costs have been annualized over a two year period. The total annualized cost is estimated to be $536,396.50.



### EXHIBIT 

### 3—E STIMATED 

### TOTAL AND 

### A NNUALIZED 

### C OST

Cost component Total cost Annualized cost

Guide Development .............................................................................................................. ................................. $526,214 $263,107 Data Collection Activities ..................................................................................................... .................................. 310,006 155,003 Data Processing and Analysis ................................................................................................... ............................ 110,620 55,310 Project Management ............................................................................................................. ................................. 20,270 10,135 Overhead ....................................................................................................................... ........................................ 105,683 52,842

Total .......................................................................................................................... ...................................... 1,072,793 536,396 .50

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: November 1, 2010. Carolyn M. Clancy,

Director.

[FR Doc. 2010–28368 Filed 11–12–10; 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:

‘‘ Standardizing Antibiotic Use in Longterm Care Settings. ’’ 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 January 14, 2011.

**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
Standardizing Antibiotic Use in Longterm Care Settings

This project seeks to contribute to AHRQ’s mission by optimizing antibiotic prescribing practices in nursing homes. Nursing homes serve as one of our most fertile breeding grounds for antibiotic-resistant strains of bacteria. Nursing home residents, with their combination of the effects of normal aging and multiple chronic diseases, have relatively high rates of infection. With high rates of respiratory, urinary, skin, and other infection comes a very high rate of antibiotic use that gives rise to Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococci (VRE), fluoroquinolone-resistant strains of a variety of bacteria, and multi-drug resistant organisms (MDROs). Inappropriate antibiotic prescribing practices by primary care clinicians caring for residents in long-term care (LTC) communities is becoming a major public health concern. Antibiotics are among the most commonly prescribed pharmaceuticals in LTC settings, yet reports indicate that a high proportion of antibiotic prescriptions are inappropriate.

In an effort to reduce antibiotic overprescribing, Loeb and colleagues