[Federal Register Volume 74, Number 42 (Thursday, March 5, 2009)]
[Notices]
[Pages 9613-9615]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-4515]


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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: ``Coordinating Care across Primary Care and Specialty Care 
Practices.'' 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 May 4, 2009.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by e-mail at 
<a href="/cdn-cgi/l/email-protection#2a4e4558435904464f4c41455d435e506a4b42585b04424259044d455c"><span class="__cf_email__" data-cfemail="c0a4afb2a9b3eeaca5a6abafb7a9b4ba80a1a8b2b1eea8a8b3eea7afb6">[email protected]</span></a>.
    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 
<a href="/cdn-cgi/l/email-protection#11757e6378623f7d74777a7e6678656b51707963603f7979623f767e67"><span class="__cf_email__" data-cfemail="c4a0abb6adb7eaa8a1a2afabb3adb0be84a5acb6b5eaacacb7eaa3abb2">[email protected]</span></a>.

SUPPLEMENTARY INFORMATION:

Proposed Project

``Coordinating Care Across Primary Care and Specialty Care Practices''

    AHRQ proposes an evaluation of the redesign of the transitions of 
care between primary care and specialty care services. The purpose of 
the redesign is to remedy inefficiencies in the current referral 
processes that threaten care quality and safety, and system efficiency. 
This redesign is being implemented at the Boston Medical

[[Page 9614]]

Center (BMC), and two affiliated health centers. The evaluation will be 
conducted for AHRQ by its contractor, the Boston University School of 
Public Health (BUSPH).
    Care coordination has been identified by the Institute of Medicine 
(IOM) as a key strategy with potential to improve the effectiveness, 
safety and efficiency of the health care system. At the same time, care 
coordination, particularly in transitions among sites of care, is often 
lacking. Research shows that problems in coordination of care and 
common failures in patients' transitioning between and among systems 
typically create serious quality concerns in many settings. Individuals 
moving across systems of care and between care providers are vulnerable 
to fragmented and disjointed care (Coleman et al., 2004). Uncoordinated 
and fragmented transitions can lead to a wide range of costly problems 
and threats to patient safety including greater use of hospital and 
emergency services (Coleman et al., 2004), ordering and completion of 
redundant tests (Coleman & Berenson, 2004), prescription and medication 
errors and use of poly-pharmacy by multiple providers (Coleman & 
Berenson, 2004). The end result is often confusion about conflicting 
care plans and lack of follow-up care. The aim of this evaluation is to 
address this confusion and fragmentation by expanding knowledge of how 
to improve the experience and outcomes for patients in transitions of 
care between primary care and specialty practices. The initial focus is 
on referrals between primary care and two specialties: gastroenterology 
(GI) and obstetrics (OB). The redesigned referral system will be tested 
by implementing it in three participating primary care sites and two 
specialty clinics. We expect that the lessons learned from this 
evaluation will provide a model and tools that can later easily be 
tested and applied to other sites and specialties in the BMC system and 
provide lessons learned to other systems seeking to sustainably improve 
their referral systems.
    This project is being conducted pursuant to AHRQ's statutory 
authority to conduct research and evaluations on health care and 
systems for the delivery of such care, including activities with 
respect to: the quality, effectiveness, efficiency, appropriateness and 
value of health care services; clinical practice, including primary 
care and practice-oriented research; and health care costs, 
productivity, organization, and market forces. See 42 U.S.C. 
299a(a)(l), (4) and (6).
    The overall aims of the evaluation are to provide a rigorous 
assessment of the success of the redesigned referral system in meeting 
its improvement goals and to gain an understanding of the 
implementation of the redesigned system.

Method of Collection

    This evaluation will include the following data collections:
    [ballot] Medical record data will be used to analyze aspects of the 
referral process, such as percentage of items on referral forms filled 
in, proportion of specialty appointments made, time between referral 
and initial specialty appointment. Patients' personal health data will 
not be analyzed. The medical record data will be used to measure both 
the fidelity of the redesigned system within the practices and success 
in meeting redesign improvement goal (outcome) indicators. The medical 
record data will be extracted by project staff and will not impose a 
burden on the participating health care sites.
    [ballot] Patient satisfaction survey will be administered to 
selected patients twice during the project. The questionnaire will be 
designed to assess patient experience in the referral system. Only 
patients with referrals to obstetrics or gastroenterology specialists 
will receive the questionnaire. These two questionnaires are 
essentially identical and vary only by the type of specialist seen; for 
the purpose of this clearance request they are treated as identical. 
Results from the first survey will provide baseline data; results from 
the second survey will provide the basis for assessing change over time 
and fidelity to the new system design.
    [ballot] Focus groups with providers, clinical staff and 
administrative staff will be conducted in each primary care site and in 
each specialty practice. The group sessions will pursue three topics: 
the extent to which the new system is being used as intended; the 
perceived effectiveness of the new system as implemented; and the 
organization and culture of the clinical setting. Themes from the focus 
groups will be used to assess fidelity of implementation, performance 
outcomes and factors affecting fidelity and outcomes.
    [ballot] Implementation logs and meeting notes kept by the project 
team throughout the redesign implementation will document the 
implementation process, including factors affecting the process, 
challenges encountered, and strategies for dealing with the challenges. 
This component of the evaluation will not impose a burden on the 
participating health care sites.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
respondents' time to participate in this two year evaluation. The 
patient satisfaction survey questionnaire will be completed by a total 
of 600 patients prior to the referral process redesign and 600 patients 
after the completion of the redesign (Exhibit 1 shows 300 per year). 
The questionnaire is estimated to take 6 minutes to complete. Focus 
groups will be conducted with about 21 clinical staff at each of the 3 
primary care sites and 2 specialty care sites (Exhibit 1 shows 2.5 
sites per year). Each focus group session will last about 45 minutes. 
The total annualized burden is estimated to be 99 hours.
    Exhibit 2 shows the estimated annualized cost burden associated 
with the respondents' time to participate in this project. The total 
annualized cost burden is estimated to be $2,620.

                                  Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
                                                                     Number of
                   Form name                        Number of      responses per     Hours per     Total burden
                                                   respondents      respondent       response          hours
----------------------------------------------------------------------------------------------------------------
Patient satisfaction survey....................            300                 2            6/60              60
Focus groups...................................              2.5              21           45/60              39
                                                ----------------------------------------------------------------
    Total......................................            302.5              na              na              99
----------------------------------------------------------------------------------------------------------------


[[Page 9615]]


                                   Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
                                                    Number of      Total burden   Average hourly    Total cost
                   Form name                       respondents         hours        wage rate*        burden
----------------------------------------------------------------------------------------------------------------
Patient satisfaction survey....................            300                60          $19.29          $1,157
Focus groups...................................              2.5              39           37.50           1,463
                                                ----------------------------------------------------------------
    Total......................................            302.5              99              na           2,620
----------------------------------------------------------------------------------------------------------------
* The hourly wage for the patient surveys is based on the national average wage. The hourly wage for the focus
  groups is based upon the weighted mean of the average wages for physicians ($58.76, n=45), clinical
  administrative staff ($17.64, n=30) and other clinical staff ($25.48, n=30). National Compensation Survey:
  Occupational Wages in the United States, U.S. Department of Labor, Bureau of Labor Statistics. June 2007,
  Summary 07-03, http://www.bls.gov/ncs/ocs/sp/ncblO9lO.pdf. Accessed December 10, 2008.

Estimated Annual Costs to the Federal Government

    Exhibit 3 shows the estimated total and annualized cost for this 
two-year evaluation. The total cost is $155,110 and includes $23,267 
for project development, $32,573 for data collection activities, 
$31,022 for data processing and analysis, $15,511 for the publication 
of results, $12,408 for project management and $40,329 for overhead.

             Exhibit 3--Estimated Total and Annualized Cost
------------------------------------------------------------------------
                                                              Annualized
                Cost component                   Total cost      cost
------------------------------------------------------------------------
Project Development...........................      $23,267      $11,633
Data Collection Activities....................       32,573       16,287
Data Processing and Analysis..................       31,022       15,511
Publication of Results........................       15,511        7,756
Project Management............................       12,408        6,204
Overhead......................................       40,329       20,164
                                               -------------------------
    Total.....................................      155,110       77,555
------------------------------------------------------------------------

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: February 24, 2009.
Carol M. Clancy,
Director.
[FR Doc. E9-4515 Filed 3-4-09; 8:45 am]
BILLING CODE 4160-90-M


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