[Federal Register Volume 74, Number 60 (Tuesday, March 31, 2009)]
[Notices]
[Pages 14560-14562]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-6956]


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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: ``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 e-mail at 
<a href="/cdn-cgi/l/email-protection#dfbbb0adb6acf1b3bab9b4b0a8b6aba59fbeb7adaef1b7b7acf1b8b0a9"><span class="__cf_email__" data-cfemail="43272c312a306d2f2625282c342a373903222b31326d2b2b306d242c35">[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#d7b3b8a5bea4f9bbb2b1bcb8a0bea3ad97b6bfa5a6f9bfbfa4f9b0b8a1"><span class="__cf_email__" data-cfemail="32565d405b411c5e5754595d455b464872535a40431c5a5a411c555d44">[email protected]</span></a>.

SUPPLEMENTARY INFORMATION: 

Proposed Project

``CAHPS Field Test of Proposed Health Information Technology Questions 
and Methodology''

    The Consumer Assessment of Healthcare Providers and Systems 
(CAHPS[supreg]) 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[supreg] 
program was designed to:
    <bullet> Make it possible to compare survey results across sponsors 
and over time;
    and
    <bullet> 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[supreg] 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[reg] 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

[[Page 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[reg] 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:
    <bullet> As much geographic distribution as possible
    <bullet> 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:
    <bullet> Mailing an advance notification letter
    <bullet> Mailing of the questionnaire and cover letter
    <bullet> Postal card reminder
    <bullet> A second mailing of the questionnaire to non-respondents
    <bullet> 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[supreg] 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[supreg] 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
----------------------------------------------------------------------------------------------------------------
                                                                            Number of
                                                               Number of    responses    Hours per      Total
                          Form name                           respondents      per        response      burden
                                                                            respondent                  hours
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CAHPS[supreg] Clinician & Group Survey, Adult Primary Care           4800            1        20/60         1600
 Questionnaire..............................................
                                                             ---------------------------------------------------
    Total...................................................         4800            1           na         1600
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[[Page 14562]]


                                   Exhibit 2--Estimated annualized cost burden
----------------------------------------------------------------------------------------------------------------
                                                                              Total       Average
                          Form name                            Number of      burden    hourly wage   Total cost
                                                              respondents     hours        rate *       burden
----------------------------------------------------------------------------------------------------------------
CAHPS[supreg] Clinician & Group Survey, Adult Primary Care           4800         1600       $19.56      $31,296
 Questionnaire..............................................
                                                             ---------------------------------------------------
    Total...................................................         4800         1600           na       31,296
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* 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[supreg] 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
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                       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
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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


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