51484 Federal Register / Vol. 73, No. 171 / Wednesday, September 3, 2008 / Notices 

A under ‘‘CERHR Reports & 

Monographs’’ or directly at http:// 

cerhr.niehs.nih.gov/chemicals/ 

bisphenol/bisphenol-eval.html.) 

SUPPLEMENTARY INFORMATION: 

Background Information on Bisphenol 

A 

Bisphenol A (CAS RN: 80–05–7) is a 

high production volume chemical used 

primarily in the production of 

polycarbonate plastics and epoxy resins. 

Polycarbonate plastics are used in some 

food and drink containers; the resins are 

used as lacquers to coat metal products 

such as food cans, bottle tops, and water 

supply pipes. To a lesser extent 

bisphenol A is used in the production 

of polyester resins, polysulfone resins, 

polyacrylate resins, and flame 

retardants. In addition, bisphenol A is 

used in the processing of polyvinyl 

chloride plastic. Some polymers used in 

dental sealants and composites may 

contribute to bisphenol A exposures. 

The primary source of exposure to 

bisphenol A for most people is assumed 

to occur through the diet. The highest 

estimated daily intakes of bisphenol A 

in the general population occur in 

infants and children. CERHR selected 

bisphenol A for evaluation because of 

(1) widespread human exposure, (2) 

public concern for possible health 

effects, (3) high production volume, and 

(4) evidence of reproductive and 

developmental toxicity in laboratory 

animal studies. 

Background Information on the CERHR 

The NTP established CERHR in 1998 

(Federal Register: December 14, 1998: 

Vol. 63, No. 239, page 68782). CERHR 

is a publicly accessible resource for 

information about adverse reproductive 

and/or developmental health effects 

associated with exposure to 

environmental and/or occupational 

exposures. CERHR follows a formal 

process for the evaluation of selected 

chemicals that includes opportunities 

for public input. 

CERHR invites the nomination of 

agents for review or scientists for its 

expert registry. Information about 

CERHR and the nomination process can 

be obtained from its homepage (http:// 

cerhr.niehs.nih.gov) or by contacting Dr. 

Michael Shelby, CERHR Director (see 

ADDRESSES). CERHR selects chemicals 

for evaluation based upon several 

factors including production volume, 

potential for human exposure from use 

and occurrence in the environment, 

extent of public concern, and extent of 

data from reproductive and 

developmental toxicity studies. Expert 

panels conduct scientific evaluations of 

agents selected by CERHR in public 

forums. Following these evaluations, 

CERHR prepares the NTP–CERHR 

monograph on the agent evaluated. The 

monograph is transmitted to appropriate 

federal and state agencies and made 

available to the public. 

Dated: August 20, 2008. 

Samuel H. Wilson, 

Acting Director, National Institute of 

Environmental Health Sciences and National 

Toxicology Program. 

[FR Doc. E8–20297 Filed 9–2–08; 8:45 am] 

BILLING CODE 4140–01–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: ‘‘Study 

of Factors Influencing Consumer 

Choices Among Health Plans and 

Clinicians.’’ 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 November 3, 2008. 

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 

‘‘Study of Factors Influencing 

Consumer Choices Among Health Plans 

and Clinicians’’ 

This study will use an experimental 

design to determine factors that 

influence consumer understanding and 

use of performance information to select 

among health plans and clinicians. 

Performance reports on health plans and 

individual providers have become 

increasingly available in recent years, 

but there is little evidence regarding 

how consumers understand and use 

different types of performance 

information to make choices. 

The study will include two parallel 

experiments, one designed to assess 

factors influencing choice of health 

plans and one designed to assess factors 

influencing choice of individual 

doctors. Both experiments will present 

a panel of online consumers with a 

simulated Web-based performance 

report. Study subjects will answer a 

series of pre-test questions, and then be 

directed to a Web site with a simulated 

report (for either health plans or 

doctors) where they will view various 

types of performance information, go 

through the process of selecting either a 

health plan or a doctor, and then 

complete the experiment by answering 

a series of post-test questions about how 

they made their selection. 

The categories of performance 

information to be included in the Web 

reports will be derived from patient 

experience survey results using 

Consumer Assessment of Healthcare 

Providers and Systems (CAHPS) 

composite measures, clinical process 

measures, personal anecdotes based on 

patient or enrollee experiences, and the 

frequency of different types of enrollee 

complaints or grievances (in the plan 

experiment only). 

The results of this study will be used 

to develop recommendations for helping 

consumers to better understand and 

more effectively use complex 

information to select health plans and 

providers, with the aim of making 

performance information less 

burdensome and more accessible, 

useful, and transparent to the public. 

The simulated Web-based reports will 

be made available as examples for other 

report developers to use. This study is 

being conducted pursuant to AHRQ’s 

statutory mandate to promote health 

care quality improvement by conducting 

and supporting research that develops 

and presents scientific evidence 

regarding all aspects of health care, 42 

U.S.C. 299(b)(1), and to conduct 

research on health care and on systems 

for the delivery of such health care, 42 

U.S.C. 299a. 

Method of Collection 

Participants in this study will be 

recruited through the Knowledge 

Networks national online panel of 

consumers. For both the health plan and 

clinician choice experiments, study 

subjects will be randomly assigned to 

one of several arms (described below) 


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Federal Register / Vol. 73, No. 171 / Wednesday, September 3, 2008 / Notices 51485 

that vary according to the type and 

complexity of performance information 

and the size of the choice set (number 

of plans or doctors) included in the Web 

report. Participants will complete the 

experiment through a secure online 

connection from their homes. 

Clinician Choice Experimental Design 

In each of the six arms, study 

participants will see a web page labeled 

‘‘Performance Overview’’ that presents 

performance information for a set of 

primary care doctors in a way that 

allows them to compare doctor ratings. 

Performance is summarized by 

assigning one to five stars to show how 

each doctor compares with others in the 

same zip code area. Participants can 

click on hyperlinks or a tab to see more 

detailed results. The experimental arms 

differ in the type and amount of 

performance information presented and 

the number of doctors listed, as 

described below: 

(1) Baseline/Control Arm: participants 

see only ‘‘Patient Survey Results’’ for 

each of 12 doctors in this arm. This 

includes a summary measure on the 

Performance Overview page and more 

detailed measures corresponding to 

CAHPS composites and an overall 

doctor rating on the drill-down page. 

(2) Experimental Arm #1: Augmented 

Quantified Performance Measures: In 

this arm participants will also see 

‘‘Patient Survey Results’’ on 12 doctors. 

In addition, they will see a summary 

clinical performance measure labeled 

‘‘Medical Quality Scores.’’ The drilldown page shows that this is based on 

clinical indicators for prevention and 

screening, care for asthma, care for 

diabetes, and care for heart disease. 

(3) Experimental Arm #2: CAHPS plus 

Anecdotes: In this arm, participants will 

again be presented with ‘‘Patient Survey 

Results’’ on 12 doctors. In addition, for 

each doctor, they will see a tab labeled 

‘‘Patient Comments.’’ By clicking on this 

tab, they can see from four to six patient 

comments describing patients’ 

experiences with each doctor. 

Participants in this arm will not see 

clinical performance scores. 

(4) Experimental Arm #3: Augmented 

Quantified Performance Measures Plus 

Anecdotes: In this arm participants will 

be presented with all three types of 

information on 12 doctors: ‘‘Patient 

Survey Results,’’ ‘‘Medical Quality 

Scores’’, and ‘‘Patient Comments.’’ 

(5) Experimental Arm #4: CAHPS plus 

Anecdotes and Larger Choice Set: In this 

arm participants will be presented with 

‘‘Patient Survey Results’’ and ‘‘Patient 

Comments’’ on 24 doctors. 

(6) Experimental Arm #5: Maximum 

Cognitive Load: Large Choice Set and 

Three Measures of Performance: In this 

arm, participants are presented with all 

three types of information on 24 

doctors: ‘‘Patient Survey Results,’’ 

‘‘Medical Quality Scores,’’ and ‘‘Patient 

Comments.’’ 

The goals of the experiment are to 

assess the process of consumer choice 

and the extent to which CAHPS-type 

measures are consulted, and to examine 

how consumers respond to different 

types of information about doctor 

quality, including quantitative patient 

experience measures, anecdotal reports 

from individual patients, and clinical 

performance indicators. The post-test 

questionnaire will elicit participants’ 

understanding and impressions of the 

material they saw on the Web site and 

inquire about how they made their 

choice. Therefore, the post-test 

questions will differ somewhat across 

experimental arms. 

Health Plan Choice Experimental 

Design 

The design of the health plan choice 

experiment has a comparable 

architecture to the clinician-choice 

experiment, but makes choices more 

challenging by adding more dimensions 

of performance measures within a 

smaller choice set. (These distinctions 

between informed clinician choice and 

informed plan choice replicate the 

information currently available to 

consumers over the internet.) In each of 

the six arms, study participants will see 

a web page labeled ‘‘Performance 

Overview’’ that presents performance 

information for a set of health plans in 

a way that allows them to compare plan 

ratings. Performance is summarized by 

assigning one to five stars to show how 

each plan compares with others in the 

same community. Participants can click 

on hyperlinks or a tab to see more 

detailed results. The experimental arms 

differ in the type and amount of 

performance information presented and 

the number of plans listed, as described 

below: 

(1) Baseline/Control Arm: participants 

see only ‘‘Patient Survey Results’’ for 

each of 4 plans in this arm. This 

includes a summary measure on the 

Performance Overview page and more 

detailed measures corresponding to 

CAHPS composites and an overall plan 

ratings on the drill-down page. 

(2) Experimental Arm #1: Augmented 

Quantified Performance Measures: In 

this arm participants will also see 

‘‘Patient Survey Results’’ on four plans. 

In addition, they will see two summary 

clinical performance measures labeled 

‘‘Health Care Quality Scores,’’ which 

will consist of selected Health Care 

Effectiveness Data and Information Set 

(HEDIS) measures, one for preventive 

care, and one for the treatment of 

chronic conditions. The drill-down page 

for prevention will show preventive 

care scores of regular physical exams, 

and screening for three common 

medical conditions. The drill down 

page for treatment will include 

summary measures for heart problems, 

asthma, diabetes, and arthritis. A 

summary score for the reported rate of 

consumer complaints will also be 

included, with a drill down reporting 

rating for the four most common causes 

of complaints, with the categories based 

on actual data from three states. 

(3) Experimental Arm #2: CAHPS plus 

Anecdotes: In this arm, participants will 

again be presented with ‘‘Patient Survey 

Results’’ on four plans. In addition, for 

each plan, they will see a tab labeled 

‘‘Patient Comments.’’ By clicking on this 

tab, they can see from four to six patient 

comments describing patients’ 

experiences with each plan. Participants 

in this arm will not see quality 

performance or rates of patient 

complaints scores. 

(4) Experimental Arm #3: Augmented 

Quantified Performance Measures Plus 

Anecdotes: In this arm participants will 

be presented with all four types of 

information for four plans: ‘‘Patient 

Survey Results,’’ ‘‘Health Care Quality 

Scores’’, ‘‘Patient Complaint Rates’’ and 

‘‘Patient Comments.’’ 

(5) Experimental Arm #4: CAHPS plus 

Anecdotes and Larger Choice Set: In this 

arm participants will be presented with 

‘‘Patient Survey Results’’ and ‘‘Patient 

Comments’’ on 12 plans. 

(6) Experimental Arm #5: Maximum 

Cognitive Load: Large Choice Set and 

Five Measures of Performance: In this 

arm, participants are presented with all 

three types of information: ‘‘Patient 

Survey Results,’’ ‘‘Health Care Quality 

Scores’’ (both prevention and 

treatment), ‘‘Patient Complaint Rates’’ 

and ‘‘Patient Comments’’ on 12 plans. 

The goal of these experiments is to 

assess the process of consumer choice 

and the extent to which CAHPS-type 

measures are consulted, and to examine 

how consumers respond to different 

types of information about plan 

performance, including quantitative 

patient experience measures, anecdotal 

reports from individual patients, 

frequency of consumer complaints, and 

clinical performance indicators. The 

post-test questionnaire will elicit 

participants’ understanding and 

impressions of the material they saw on 

the Web site and inquire about how they 

made their choice. Therefore, the posttest questions will differ somewhat 

across experimental arms. 


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51486 Federal Register / Vol. 73, No. 171 / Wednesday, September 3, 2008 / Notices 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden hours for the 

respondents’ time to participate in this 

experiment. This experiment will not 

exceed one year. All participants will 

complete the pre-test which is estimated 

to require 5 minutes. As explained 

above, the experimental Web site varies 

by experimental arm, however, each 

participant is expected to require about 

10 minutes to review the information on 

the site. The baseline/control post-test 

will be completed by 170 participants 

and will require about 7 minutes to 

complete. Both the experimental arm #1 

and #2 post-test will be completed by 

166 participants each and will take 

about 8 minutes. Both the experimental 

arm #3 and #4 post-test will be 

completed by 166 participants each and 

will require about 12 minutes to 

complete. The experimental arm #6 

post-test will be completed by 166 

participants and will require about 14 

minutes to complete. The total burden 

hours are estimated to be 838 hours. 

Exhibit 2 shows the respondents’ cost 

burden for their time to participate in 

this experiment. The total cost burden is 

estimated to be $16,142. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Experimental group Number of 

responses 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Clinician Choice Experiment: 

Pretest ...................................................................................................... 1,000 1 5/60 83 

Experimental Web site ............................................................................. 1,000 1 10/60 167 

Baseline/Control Post-test ........................................................................ 170 1 7/60 20 

Experimental Arm #1 Post-test ................................................................. 166 1 8/60 22 

Experimental Arm #2 Post-test ................................................................. 166 1 8/60 22 

Experimental Arm #3 Post-test ................................................................. 166 1 12/60 33 

Experimental Arm #4 Post-test ................................................................. 166 1 12/60 33 

Experimental Arm #5 Post-test ................................................................. 166 1 14/60 39 

Health Plan Choice Experiment: 

Pretest ...................................................................................................... 1,000 1 5/60 83 

Experimental Web site ............................................................................. 1,000 1 10/60 167 

Baseline/Control Post-test ........................................................................ 170 1 7/60 20 

Experimental Arm #1 Post-test ................................................................. 166 1 8/60 22 

Experimental Arm #2 Post-test ................................................................. 166 1 8/60 22 

Experimental Arm #3 Post-test ................................................................. 166 1 12/60 33 

Experimental Arm #4 Post-test ................................................................. 166 1 12/60 33 

Experimental Arm #5 Post-test ................................................................. 166 1 14/60 39 

Total ................................................................................................... 6,000 na na 838 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Experimental group Number of 

responses 

Total burden 

hours 

Average hourly wage rate* Total cost 

burden 

Clinician Choice Experiment: 

Pretest ...................................................................................................... 1,000 83 $19.26 $1,599 

Experimental Web site ............................................................................. 1,000 167 19.26 3,216 

Baseline/Control Post-test ........................................................................ 170 20 19.26 385 

Experimental Arm #1 Post-test ................................................................. 166 22 19.26 424 

Experimental Arm #2 Post-test ................................................................. 166 22 19.26 424 

Experimental Arm #3 Post-test ................................................................. 166 33 19.26 636 

Experimental Arm #4 Post-test ................................................................. 166 33 19.26 636 

Experimental Arm #5 Post-test ................................................................. 166 39 19.26 751 

Health Plan Choice Experiment: 

Pretest ...................................................................................................... 1,000 83 19.26 1,599 

Experimental Web site ............................................................................. 1,000 167 19.26 3,216 

Baseline/Control Post-test ........................................................................ 170 20 19.26 385 

Experimental Arm #1 Post-test ................................................................. 166 22 19.26 424 

Experimental Arm #2 Post-test ................................................................. 166 22 19.26 424 

Experimental Arm #3 Post-test ................................................................. 166 33 19.26 636 

Experimental Arm #4 Post-test ................................................................. 166 33 19.26 636 

Experimental Arm #5 Post-test ................................................................. 166 39 19.26 751 

Total ................................................................................................... 6,000 838 na 16,142 

*Based upon the mean of the average wages, National Compensation Survey: Occupational wages in the United States 2006, ‘‘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 and 

conducting both the health plan and 

clinician choice components of this 

study is $844,000, including the cost of 

designing the experiments, developing 

the simulated Web-based reports, 

conducting usability testing of the Webreports, pilot testing the experiment, 

collecting the data, analyzing the data, 

preparing reports and papers for journal 

submission, and the cost for AHRQ staff 


sroberts on PROD1PC70 with NOTICES
Federal Register / Vol. 73, No. 171 / Wednesday, September 3, 2008 / Notices 51487 

to oversee the project; see Exhibit 3. The 

annualized cost for this two year project 

is $422,000. 

EXHIBIT 3—PROJECT COST

COMPONENTS

Cost components Cost 

estimate 

Experimental design ................... $168,900 

Development of simulated Webbased reports .......................... 157,900 

Pilot testing ................................. 56,000 

Usability testing of Web-based 

reports ..................................... 56,300 

Data collection via Knowledge 

Networks ................................. 126,000 

Data analysis .............................. 56,300 

Preparation of reports and journal papers ............................... 112,600 

AHRQ project management 110,000 

Total ..................................... 844,000 

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 OMB approval of the 

proposed information collection. All 

comments will become a matter of 

public record. 

Dated: August 26, 2008. 

Carolyn M. Clancy, 

Director. 

[FR Doc. E8–20315 Filed 9–2–08; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

National Health and Nutrition 

Examination Survey (NHANES) Stored 

Biologic Specimens: Guidelines for 

Proposals To Use Samples and 

Proposed Cost Schedule 

AGENCY: Centers for Disease Control and 

Prevention, Department of Health and 

Human Services. 

ACTION: Notice and request for 

comments. 

SUMMARY: The National Health and 

Nutrition Examination Survey 

(NHANES) is a program of periodic 

surveys conducted by the National 

Center for Health Statistics (NCHS) of 

the Centers for Disease Control and 

Prevention (CDC). Examination surveys 

conducted since 1960 by NCHS, have 

provided national estimates of health 

and nutritional status of the United 

States civilian non-institutionalized 

population. To add to the large amount 

of information collected for the purpose 

of describing the health of the 

population in the most recent survey, 

serum, urine and limited plasma 

samples were collected and stored for 

future research projects. Specimens are 

currently available from NHANES III 

(conducted from 1988–1994) and from 

NHANES 1999+. In 1999, NHANES 

became a continuous survey with data 

release every two years. Specimens are 

available from two year survey cycles 

after the demographic file has been 

released to the public. Participants in 

the survey that began in 1999 signed a 

separate consent document agreeing to 

specimen storage allowing their biologic 

specimens to be used for approved 

research projects. 

Specimens are stored in two 

Specimen Banks. Surplus samples that 

were initially used for laboratory assays 

included in the surveys, have since been 

stored at ¥70°C and have been through 

at least two freeze-thaw cycles. They are 

stored at a commercial repository under 

contract to NCHS. In addition, on 

average, six vials of sera were also 

stored in vapor-phase liquid nitrogen at 

the CDC and ATSTR Specimen 

Packaging, Inventory and Repository 

(CASPIR) Repository in Lawrenceville, 

GA. These specimens have not 

undergone a freeze-thaw cycle. The 

CASPIR Repository is considered a longterm repository for the NHANES 

specimens. NCHS is making both of 

these collections available for research 

proposals. The research proposals that 

can use the surplused specimens will 

receive higher priority. Proposals that 

request the specimens in CASPIR need 

to justify the use of the unthawed 

specimens. 

The purpose of this notice is to 

request comments on this program and 

the proposed cost schedule. After 

consideration of comments submitted, 

CDC will finalize and publish the cost 

schedule and accept proposals for use of 

the NHANES stored biologic samples. 

Please go to http://www.cdc.gov/nchs/ 

about/major/nhanes/serum1b.htm for 

final proposal guidelines. 

All interested researchers are 

encouraged to submit proposals. No 

funding is provided as part of this 

solicitation. Samples will not be 

provided to those projects requiring 

funding until the project has received 

funds. Approved projects that do not 

obtain funding will be canceled. A more 

complete description of this program 

follows. 

DATES:

• Comment Receipt Date: October 3, 

2008. 

• Invitation to Submit Proposals: Can 

be submitted on an ongoing basis. 

• Scientific Review Date: Within two 

months of proposal submission. 

• Institutional Review Date: Within 

one month of final proposal acceptance. 

• Anticipated distribution of samples: 

One month after IRB approval. 

ADDRESSES: To send comments and to 

request information, contact: Dr. 

Geraldine McQuillan, Division of Health 

and Nutrition Examination Surveys, 

National Center for Health Statistics, 

Centers for Disease Control and 

Prevention, 3311 Toledo Road, Room 

4204, Hyattsville, MD 20782, Phone: 

301–458–4371, Fax: 301–458–4028, Email gmm2@cdc.gov. Internet: http:// 

www.cdc.gov/nchs/about/major/ 

nhanes/serum1b.htm. 

Authority: Sections 301, 306 and 308 of the 

Public Health Service Act (42 U.S.C. 241, 

242k and 242M). 

SUPPLEMENTARY INFORMATION: The goals 

of NHANES are: (1) To estimate the 

number and percent of persons in the 

U.S. population and designated 

subgroups with selected diseases and 

risk factors; (2) to monitor trends in the 

prevalence, awareness, treatment and 

control of selected diseases; (3) to 

monitor trends in risk behaviors and 

environmental exposures; (4) to analyze 

risk factors for selected diseases; (5) to 

study the relationship between diet, 

nutrition and health; (6) to explore 

emerging public health issues and new 

technologies; and, (7) to establish and 

maintain a national probability sample 


sroberts on PROD1PC70 with NOTICES