14560 Federal Register / Vol. 74, No. 60 / Tuesday, March 31, 2009 / Notices 

Estimated Annual Costs to the Federal 

Government 

a. AHRQ 

By statute, AHRQ must collect and 

review certifications from an entity that 

seeks listing or continued listing as a 

PSO under the Patient Safety Act. 

Additional information collection is 

also required for entities to remain 

listed as a PSO (i.e., submissions 

regarding compliance with the two bona 

fide contracts requirement and reports 

of certain relationships between a PSO 

and each of its contracting providers). 

The cost to AHRQ of processing the 

information collected with the abovedescribed forms is minimal: An 

estimated equivalent of approximately 

0.05 FTE or $7,500 per year and 

virtually no new overhead costs. 

Description Amount 

Personnel & Support Staff .............. $7,500 

Consultant (sub-contractor) services .............................................. 0 

Equipment ....................................... 0 

Supplies .......................................... 0 

All other expenses .......................... 0 

Average Annual Cost .............. 7,500 

b. OCR 

OCR cannot conduct its work without 

collecting information through its 

proposed complaint forms. Even if OCR 

did not use complaint forms and only 

took information orally, it would still 

have to capture the same information in 

order to begin processing a complaint. 

Therefore, the incremental cost to OCR 

of processing the information collected 

from the complaint form is minimal and 

is equivalent to approximately 0.05 FTE 

or $7,500 per year with virtually no new 

overhead costs. 

Description Amount 

Personnel & Support Staff .............. $7,500 

Consultant (sub-contractor) services .............................................. 0 

Equipment ....................................... 0 

Supplies .......................................... 0 

All other expenses .......................... 0 

Average Annual Cost .............. 7,500 

Request for Comments 

In accordance with the above-cited 

Paperwork Reduction Act legislation, 

comments on the above-described 

AHRQ and OCR information collection 

to implement the Patient Safety Act 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, 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: March 18, 2009. 

Carolyn M. Clancy, 

Director, AHRQ. 

[FR Doc. E9–6955 Filed 3–30–09; 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: ‘‘CAHPS 

Field Test of Proposed Health 

Information Technology Questions and 

Methodology.’’ In accordance with the 

Paperwork Reduction Act of 1995, 

Public Law 104–13 (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 June 1, 2009. 

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 

‘‘CAHPS Field Test of Proposed Health 

Information Technology Questions and 

Methodology’’ 

The Consumer Assessment of 

Healthcare Providers and Systems 

(CAHPS®) program is a multi-year 

initiative of the Agency for Healthcare 

Research and Quality. AHRQ first 

launched the program in October 1995 

in response to concerns about the lack 

of good information about the quality of 

health plans from the enrollees’ 

perspective. Numerous public and 

private organizations collected 

information on enrollee and patient 

satisfaction, but the surveys varied from 

sponsor to sponsor and often changed 

from year to year. The CAHPS® program 

was designed to: 

• Make it possible to compare survey 

results across sponsors and over time; 

and 

• Generate tools and resources that 

sponsors can use to produce 

understandable and usable comparative 

information for consumers. 

Over time, the program has expanded 

beyond its original focus on health 

plans to address a range of health care 

services and meet the various needs of 

health care consumers, purchasers, 

health plans, providers, and 

policymakers. Based on the literature 

review and an assessment of currently 

available survey instruments, AHRQ 

identified the need to develop a new 

health information technology module 

of the CAHPS® survey. The intent of the 

planned module is to examine in greater 

detail than previously patients’ 

perspective on health information 

technology use by their health care 

professionals. The intent of the new 

module is to provide information to 

clinicians, group practices, health plans, 

and other interested parties regarding 

the impact of the use of health 

information technology on patients’ 

experiences with care. The set of 

questions about health information 

technology will be tested as a part of 

CAHPS® Clinician & Group Survey, 

Adult Primary Care Questionnaire. 

This study, funded through 

cooperative agreements with RAND and 

Harvard, 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 

(1) the quality, effectiveness, efficiency, 

appropriateness and value of health care 

services and (2) health care 


tjames on PRODPC61 with NOTICES
Federal Register / Vol. 74, No. 60 / Tuesday, March 31, 2009 / Notices 14561 

technologies, facilities and equipment. 

See 42 U.S.C. 299a(a)(1) and (5). 

This study is a one-time field test to 

be conducted in calendar year 2009. The 

field test to be conducted under this 

request will be done for the following 

purposes: 

a. Analysis of revised item wording— 

Assess candidate wordings for survey 

items 

b. Mode Analysis—Evaluate the 

equivalence of items administered by 

mail, telephone, and internet; compare 

the characteristics and responses of 

respondents who complete the survey 

by different modes of administration. 

c. Case mix adjustment analysis— 

Evaluate variables that need to be 

considered for case mix adjustment of 

scores. 

d. Psychometric Analysis-Provide 

information for the revision and 

shortening of questionnaires based on 

the assessment of the reliability and 

validity of survey items and composites. 

The end result will be a data 

collection related to the assessment of 

patients’ perspective on how well health 

information technology is being used by 

health care professionals. The field 

testing will ensure that the future data 

collection yields high quality data and 

to ensure a minimization of respondent 

burden, increase agency efficiency, and 

improve responsiveness to the public. 

The survey items will be added to 

currently available CAHPS® surveys 

and will provide a venue to clinicians 

and practitioners to verify the quality of 

their services. 

Method of Collection 

Respondents will be selected from 

four purposively chosen sites (health 

care providers and health insurance 

plans) that have implemented health 

information technology systems, such as 

electronic health records (EHRs) and 

electronic prescription refills, that are 

used by sufficient numbers of enrollees 

(i.e., at least 2400 enrollees per site). 

From each site the potential respondent 

universe will be patients who have been 

receiving care from a clinician at the 

health provider for at least one year 

prior to the survey and who have used 

one or more features of the health 

providers’ EHR system. EHR systems 

managers have the ability to track which 

patients log on to the system, and which 

features (e.g., examine lab results, 

request prescription refill, etc.) the 

patients used. The sample selection at 

each site will be carried out jointly by 

senior leadership at the site (e.g., chief 

information officer) and a survey vendor 

experienced in conducting the CAHPS 

survey. We will ask the sites to provide 

a list of their enrollees who have seen 

a provider in the last 12 months and 

who have logged onto the EHR system 

in the last 12 months. We will randomly 

select a sample of these enrollees for the 

field test. We will use common 

statistical techniques to select the 

sample, e.g., computerized random 

number generation applied to a list of 

enrollees. When possible, we will 

stratify the enrollees at a site based on 

extent of HIT exposure to ensure a mix 

of different enrollees in the study (e.g., 

enrollees who use many HIT functions 

versus those who use few HIT 

functions). Institutional Review Boards 

(IRBs) at Harvard and RAND evaluated 

the study to ensure proper protection of 

patients’ right to privacy and 

confidentiality as well as avoidance of 

harm. The study received approvals 

from both IRBs. 

The draw will be a sample large 

enough to yield approximately 4,800 

respondents. 

Because we are assuming a 50% 

response rate, we will draw 

approximately 9,600 patients to achieve 

our total of 4,800 respondents. 

Sites to be selected will meet the 

following requirements: 

• As much geographic distribution as 

possible 

• Substantial number of patients with 

exposure to health information 

technology 

We anticipate a mixed mail-telephone 

mode of data collection which will 

include the following steps: 

• Mailing an advance notification 

letter 

• Mailing of the questionnaire and 

cover letter 

• Postal card reminder 

• A second mailing of the 

questionnaire to non-respondents 

• Minimum of six telephone calls to 

every mail non-respondent 

approximately two weeks after the final 

mailing to complete a telephone 

interview 

We will also administer the survey by 

Internet to some of the study 

participants. For those assigned to 

Internet administration an e-mail 

invitation will be sent that includes an 

invitation to participate along with a 

URL link to a Web-based survey hosted 

on a secure server. Sites will be divided 

between RAND’s Survey Research 

Group and the Center for Survey 

Research, University of Massachusetts, 

Boston (CSR). RAND will use the 

software CfMC to administer the survey, 

while CSR will use Snap software. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden for the respondents’ 

time to participate in this data 

collection. The CAHPS® Clinician & 

Group Survey, Adult Primary Care 

Questionnaire will be completed by 

about 4,800 persons. The estimated 

response time of 20 minutes is based on 

the written length of the survey and 

AHRQ’s experience with previous 

CAHPS® surveys of comparable length 

that were fielded with a similar, 

although not identical, population. The 

total burden hours are estimated to be 

1,600 hours. 

Exhibit 2 shows the respondents’ cost 

burden associated with their time to 

participate in this data collection. The 

total cost burden is estimated to be 

$31,296. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

respondents 

Number of 

responses 

per respondent 

Hours per 

response 

Total burden hours 

CAHPS® Clinician & Group Survey, Adult Primary Care Questionnaire ........................ 4800 1 20/60 1600 

Total .......................................................................................................................... 4800 1 na 1600 


tjames on PRODPC61 with NOTICES
14562 Federal Register / Vol. 74, No. 60 / Tuesday, March 31, 2009 / Notices 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Form name Number of 

respondents 

Total burden hours 

Average 

hourly wage 

rate * 

Total cost 

burden 

CAHPS® Clinician & Group Survey, Adult Primary Care Questionnaire ........................ 4800 1600 $19.56 $31,296 

Total .......................................................................................................................... 4800 1600 na 31,296 

* Based upon the average wages, ‘‘National Compensation Survey: Occupational Wages in the United States, May 2007,’’ U.S. Department of 

Labor, Bureau of Labor Statistics. 

Estimated Annual Costs to the Federal 

Government 

The total cost to the Federal 

Government for developing the Health 

Information Technology questions, and 

testing them within the CAHPS®

Clinician & Group Survey, Adult 

Primary Care Questionnaire, is 

$780,000, including the cost of 

reviewing the literature, conducting 

focus groups and cognitive interviews, 

field testing the instrument, analyzing 

the data, finalizing the survey, preparing 

reports, writing papers for journal 

submission, and project management 

(see Exhibit 3). Data collection will not 

exceed one year. 

EXHIBIT 3—ESTIMATED ANNUAL COST

Cost component Total cost 

Review of literature ................... $35,000 

Focus groups ............................ 60,000 

Cognitive interviews .................. 80,000 

Field test ................................... 260,000 

Data analyses ........................... 80,000 

Finalize survey .......................... 50,000 

Preparation of reports and journal papers ............................. 85,000 

AHRQ project management ..... 130,000 

Total ................................... $780,000 

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 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 0MB approval of the 

proposed information collection. All 

comments will become a matter of 

public record. 

Dated: March 20, 2009. 

Carolyn M. Clancy, 

Director. 

[FR Doc. E9–6956 Filed 3–30–09; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[60Day–09–09BH] 

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 email 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 

Assessing the Safety Culture of 

Underground Coal Mining—New— 

National Institute for Occupational 

Safety and Health, (NIOSH), Centers for 

Disease Control and Prevention, (CDC). 

Background and Brief Description 

NIOSH, under Public Law 91–596, 

Sections 20 and 22 (Section 20–22, 

Occupational Safety and Health Act of 

1970) has the responsibility to conduct 

research relating to innovative methods, 

techniques, and approaches dealing 

with occupational safety and health 

problems. 

This research would relate to 

occupational safety and health problems 

in the coal mining industry. In recent 

years, coal mining safety has attained 

national attention due to highly 

publicized disasters. Despite these 

threats to worker safety and health, the 

U.S. relies on coal mining to meet its 

electricity needs. For this reason, the 

coal mining industry must continue to 

find ways to protect its workers while 

maintaining productivity. One way to 

do so is through improving the safety 

culture at coal mines. In order to 

achieve this culture, operators, 

employees, the inspectorate, etc. must 

share a fundamental commitment to it 

as a value. This type of culture is known 

in other industries as a ‘‘safety culture’’ 

and can be defined as the characteristics 

of the work environment, such as the 

norms, rules, and common 

understandings that influence facility 

personnel’s perceptions of the 

importance that the organization places 

on safety. 

NIOSH proposes an assessment of the 

current safety culture of underground 

coal mining in order to identify 

recommendations for promoting and 

ensuring the existence of a positive 

safety culture across the industry. A 

total of 6 underground coal mines will 

be studied for this assessment. The 

assessment includes the collection of 

data using several diagnostic tools: 


tjames on PRODPC61 with NOTICES