[Federal Register Volume 74, Number 91 (Wednesday, May 13, 2009)]
[Notices]
[Pages 22554-22556]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-11009]


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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.
    This proposed information collection was previously published in 
the Federal Register on March 5th, 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. This notice differs 
from the 60 day notice in that the Patient Satisfaction Survey has been 
eliminated.

DATES: Comments on this notice must be received by June 12, 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#37787e6576684442555a5e44445e585977585a551952584719505841"><span class="__cf_email__" data-cfemail="9ad5d3c8dbc5e9eff8f7f3e9e9f3f5f4daf5f7f8b4fff5eab4fdf5ec">[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#1f7b706d766c31737a79747068766b655f7e776d783177776c31787069"><span class="__cf_email__" data-cfemail="34505b465d471a5851525f5b435d404e74555c46531a5c5c471a535b42">[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 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

[[Page 22555]]

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)(1), (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:
    <bullet> 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.
    <bullet> 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.
    <bullet> 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. 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 39 hours.

                                  Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
                                                                     Number of
                    Form name                        Number of    responses  per     Hours per     Total burden
                                                    respondents      respondent      response          hours
----------------------------------------------------------------------------------------------------------------
Focus groups....................................             2.5              21           45/60              39
                                                 ---------------------------------------------------------------
    Total.......................................             2.5              na              na              39
----------------------------------------------------------------------------------------------------------------

    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 $1,463.

                                   Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                    Form name                        Number of     Total burden     hourly wage     Total cost
                                                    respondents        hours           rate*          burden
----------------------------------------------------------------------------------------------------------------
Focus groups....................................             2.5              39          $37.50          $1,463
                                                 ---------------------------------------------------------------
    Total.......................................             2.5              39              na           1,463
----------------------------------------------------------------------------------------------------------------
* The hourly wage 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 0703, http://www.bls.gov/ncs/ocs/sp/ncblo9 1 0.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.

[[Page 22556]]



             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
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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, 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: May 4, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9-11009 Filed 5-12-09; 8:45 am]
BILLING CODE 4160-90-M


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