[Federal Register Volume 74, Number 49 (Monday, March 16, 2009)]
[Notices]
[Pages 11109-11111]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-5581]


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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: ``Improving Patient Flow and Reducing Emergency Department 
Crowding.'' 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.
    This proposed information collection was previously published in 
the Federal Register on January 15th, 2009 and allowed 60 days for 
public comment. One comment was 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 April 15, 2009.

ADDRESSES: Written comments should be submitted to: AHRQ's OMB Desk 
Officer by fax at (202) 395-6974 (attention: AHRQ's desk officer) or by 
e-mail at <a href="/cdn-cgi/l/email-protection#f2bdbba0b3ad8187909f9b81819b9d9cb29d9f90dc979d82dc959d84"><span class="__cf_email__" data-cfemail="7d32342f3c220e081f10140e0e1412133d12101f5318120d531a120b">[email protected]</span></a> (attention: AHRQ's desk 
officer).
    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#4f2b203d263c61232a29242038263b350f2e273d3e6127273c61282039"><span class="__cf_email__" data-cfemail="5e3a312c372d70323b38353129372a241e3f362c2f7036362d70393128">[email protected]</span></a>.

SUPPLEMENTARY INFORMATION: 

Proposed Project

    ``Improving Patient Flow and Reducing Emergency Department 
Crowding'' AHRQ proposes to study implementation of strategies from the 
Urgent Matters (UM) Toolkit for improving patient flow in emergency 
departments (ED). UM, a Robert Wood Johnson Foundation (RWJF) funded 
initiative, began as a collaborative of 10 urban, safety net hospitals 
that experimented with a variety of strategies (now included in the 
``UM Toolkit'') designed to relieve ED crowding. The first phase of 
this initiative demonstrated that reductions in ED crowding were 
achievable without investment of significant financial resources. 
However, implementation of these strategies has not been widespread, 
and questions remain about how readily the strategies could be 
implemented in a more diverse group of hospitals, and the associated 
costs and outcomes of implementation. This study is funded by a grant 
from RWJF to AHRQ.
    Six diverse hospitals have been selected for this study of the 
implementation of strategies from the UM Toolkit for improving ED 
patient flow. This study poses a common outcome goal across all six 
sites of improving patient flow and reducing ED crowding, but requires 
each hospital to select strategies that fit its own needs and context. 
This approach rests on innovation research showing that organizational 
innovations are more successful when they are aligned with features of 
the adopting hospital. Participating hospitals will select strategies 
from the UM Toolkit that they believe will work best to address the 
particular problems they face. The six hospitals have agreed to 
participate in a collaborative run by the UM National Program Office 
(NPO) over the course of this study to facilitate the sharing of data 
and experiences while the project is underway.
    This study will document the experiences of a diverse set of 
hospital EDs as they identify and implement ED patient flow improvement 
strategies. The six case study hospitals were selected to reflect 
diversity of size, ownership, teaching status, safety net status, and 
types of challenges with ED crowding.
    Research methods will include observational site visits, in-person 
and telephone interviews, and the analysis of cost data. AHRQ's 
contractor for this study, Health Research & Educational Trust (HRET), 
will perform analysis of secondary data on ED performance measures; 
this secondary data will be provided to HRET by the Urgent Matters NPO. 
These qualitative and quantitative methods will be used to:
    <bullet> Study the processes through which hospitals decide upon 
and adopt patient flow improvement strategies;

[[Page 11110]]

    <bullet> Identify facilitators and barriers to the implementation 
and maintenance of these strategies;
    <bullet> Document changes in patient flow, patient satisfaction, 
and staff satisfaction associated with the implementation of strategies 
and processes;
    <bullet> Generate estimates of the costs of adopting the 
strategies;
    <bullet> Identify issues associated with the reporting of ED 
performance measures; and,
    <bullet> Develop lessons for hospitals considering the adoption of 
patient flow improvement strategies.
    The study will not be used to answer questions about causality or 
degrees of effectiveness (e.g., to what degree did a given intervention 
cause an improvement in patient flow?). Rather, the study seeks to 
enhance understanding of factors affecting decision-making and adoption 
processes that facilitate or hinder implementation. Insights and 
lessons learned about organizational, technical and resource challenges 
arising from these improvement activities may be of interest or benefit 
to others seeking to identify and adopt strategies to address similar 
problems in their EDs.
    This study is being conducted 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; quality measurement and improvement; and health 
care costs, productivity, organization, and market forces. 42 U.S.C. 
299a(a)(1), (2), and (6).

Method of Collection

    AHRQ seeks approval for the following data collection activities:
    In-person interviews will be conducted within two months of the 
implementation with up to 12 individuals at each of the 6 sites during 
two-day site visits to each of the hospitals.
    Telephone interviews will be conducted approximately 6 months after 
implementation with 12 individuals from each of the six hospitals (most 
or all of whom will be the same individuals interviewed in person).

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
hospitals' time to participate in this study. In-person interviews will 
be conducted within two months of implementation with 12 administrative 
and clinical personnel from each of the six participating hospitals and 
will require about one hour. Telephone interviews will be conducted 
approximately six months thereafter with 12 individuals (administrative 
and clinical) from each hospital and will take about 45 minutes. The 
total estimated burden for participation in this study is 126 hours.

                                  Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
                                                                     Number of
                 Data collection                     Number of     responses per     Hours per     Total burden
                                                     hospitals       hospital        response          hours
----------------------------------------------------------------------------------------------------------------
In-person interviews............................               6              12             1.0              72
Telephone interviews............................               6              12           45/60              54
                                                 ---------------------------------------------------------------
    Total.......................................              12              na              na             126
----------------------------------------------------------------------------------------------------------------

    Exhibit 2 shows the estimated annualized cost burden for the 
respondents' time to provide the requested data. The total cost burden 
is approximately $4,419.

                                   Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
                                                                   Total burden   Average hourly    Total cost
                         Data collection                               hours        wage rate *       burden
----------------------------------------------------------------------------------------------------------------
In-person interviews............................................              72          $35.07          $2,525
Telephone interviews............................................              54          $35.07           1,894
                                                                 -----------------------------------------------
    Total.......................................................             126              na           4,419
----------------------------------------------------------------------------------------------------------------
* For the interviews, the hourly rate of $35.07 is an average of the admini strative personnel hourly wage of
  $14.53, the physician rate of $62.52, and the registered nurse rate of $28.15. National Compensation Survey:
  Occupational Wages in the United States 2005, U.S. Department of Labor, Bureau of Labor Statistics.

Estimated Annual Costs to the Federal Government

    Exhibit 3 shows the total and annualized cost to the government for 
this eighteen-month study.

                        Exhibit 3--Estimated Cost
------------------------------------------------------------------------
                                                            Annualized
             Cost component                 Total cost         cost
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Project Development.....................          52,446          34,964
Data Collection Activities..............          90,298          60,199

[[Page 11111]]

 
Data Processing and Analysis............          70,569          47,046
Publication of Results..................          41,420          27,613
Project Management......................          68,908          45,939
Overhead................................          76,320          50,880
                                         -------------------------------
    Total...............................        $399,961         266,641
------------------------------------------------------------------------

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's 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: March 9, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9-5581 Filed 3-13-09; 8:45 am]
BILLING CODE 4160-90-M


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