28502 Federal Register / Vol. 74, No. 114 / Tuesday, June 16, 2009 / Notices 

Request for Comments 

Written comments and/or suggestions 

from the public and affected agencies 

are invited on one or more of the 

following points: (1) Whether the 

proposed collection of information is 

necessary for the proper performance of 

the agency, including whether the 

information will have practical utility; 

(2) The accuracy of the agency’s 

estimate of the proposed collection of 

information, including the validity of 

the methodology and assumptions used; 

(3) Ways to enhance the quality, utility, 

and the clarity of information to be 

collected; and (4) Ways to minimize the 

burden of the collection of information 

on those who are to respond, including 

the use of appropriate automated, 

electronic, mechanical, or other 

technological collection techniques or 

other forms of information technology. 

FOR FURTHER INFORMATION CONTACT: To 

request more information on the 

proposed project or to obtain a copy of 

the data collection plans and 

instruments, contact: Steven Alves, 

Website Programs Specialist, Office of 

Intramural Training and Education, OD, 

NIH, Building 2, Room 2E06, 2 Center 

Drive MSC 0240, Bethesda, MD 20892– 

0240, or call non-toll-free number 301– 

402–1294, or e-mail your request, 

including your address to: 

alvess@mail.nih.gov. 

Comments Due Date: Comments 

regarding this information collection are 

best assured of having their full effect if 

received within 60 days of the date of 

this publication. 

Dated: June 9, 2009. 

Sharon Milgram, 

Director, Office of Intramural Training & 

Education, National Institutes of Health. 

[FR Doc. E9–14156 Filed 6–15–09; 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: ‘‘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. 

This proposed information collection 

was previously published in the Federal 

Register on March 31, 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 the 

following ways: (1) The number of 

respondents has been increased from 

4,800 to 7,200; (2) the burden hours are 

increased from 1,600 to 2,400; (3) an 

incentive experiment has been added; 

and (4) an experiment testing the use of 

a 4-point vs. 6-point response scale has 

been added. 

DATES: Comments on this notice must be 

received by July 16, 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 

OIRA_submission@omb.eop.gov 

(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 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 

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. 

e. Test a 4-point vs. a 6-point response 

scale—The CAHPS Clinician & Group 

Survey will test both a 4-point response 

scale (Never, Sometimes, Usually, 

Always) and a 6-point response scale 

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Federal Register / Vol. 74, No. 114 / Tuesday, June 16, 2009 / Notices 28503 

(Never, Almost Never, Sometimes, 

Usually, Almost Always, Always). For 

those sites already employing the 6- 

point response scale, a subset of 

questions will be repeated using the 4- 

point scale. This will allow comparison 

of item performance within a site across 

both versions of the response scale, and 

collect data that can be used to inform 

comparison of data collected using the 

two versions of the response scales. 

f. Incentive experiment—Provide 

information on the effectiveness of a 

post-paid, $5 incentive as a mechanism 

to enhance response by randomizing 

half the sample at one site to an 

experiment in which a post-paid 

incentive of $5 is provided for 

completing the survey. 

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 six 

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 7,200 

respondents. Because we are assuming a 

50% response rate, we will draw 

approximately 14,400 patients to 

achieve our total of 7,200 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 7,200 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 

2,400 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 

$46,944. 

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 ....... 7,200 1 20/60 2,400 

Total .......................................................................................................... 7,200 1 na 2,400

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 ....... 7,200 2,400 $19.56 $46,944 

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28504 Federal Register / Vol. 74, No. 114 / Tuesday, June 16, 2009 / Notices 

EXHIBIT 2. ESTIMATED ANNUALIZED COST BURDEN—Continued 

Form Name Number of 

respondents 

Total burden 

hours 

Average 

hourly wage 

rate* 

Total cost burden 

Total .......................................................................................................... 7,200 2,400 na 46,944 

*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 OMB approval of the 

proposed information collection. All 

comments will become a matter of 

public record. 

Dated: June 4, 2009. 

Carolyn M. Clancy, 

Director. 

[FR Doc. E9–14080 Filed 6–15–09; 8:45 am] 

BILLING CODE 4160–90–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: ‘‘2010– 

2011 Medical Expenditure Panel Survey 

Insurance Component.’’ 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. 

DATES: Comments on this notice must be 

received by August 17, 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 

2010–2011 Medical Expenditure Panel 

Survey Insurance Component 

AHRQ seeks to renew the Medical 

Expenditure Panel Survey Insurance 

Component (MEPS–IC) for calendar 

years 2010 and 2011. The MEPS–IC, an 

annual survey of the characteristics of 

employer-sponsored health insurance, 

was first conducted by AHRQ in 1997 

for the calendar year 1996. The survey 

has since been conducted annually for 

calendar years 1996 through 2009, 

except for 2007. A change from prior 

year collection to calendar year 

collection in 2008 meant that no data 

were collected for the 2007 calendar 

year, but the change has allowed for 

much earlier release of the survey 

results for the 2008 calendar year 

forward. AHRQ is authorized to conduct 

the MEPS–IC pursuant to 42 U.S.C. 

299b-2. 

Employment-based health insurance 

is the source of coverage for over 90 

million workers and their family 

members, and is a cornerstone of the 

current U.S. health care system. The 

MEPS–IC measures the extent, cost, and 

coverage of employment-based health 

insurance. Statistics are produced at the 

National, State, and sub-State 

(metropolitan area) level. 

The MEPS–IC is designed to provide 

data for Federal policymakers 

evaluating the effects of National and 

State health care reforms. It also 

provides descriptive data on the current 

employment-based health insurance 

system and data for modeling the 

differential impacts of proposed health 

policy initiatives. The MEPS–IC also 

supplies critical State and National 

estimates of health insurance spending 

for the National Health Accounts and 

Gross Domestic Product. Data to be 

collected from each employer will 

include a description of the organization 

(e.g., size, industry) and descriptions of 

health insurance plans available, plan 

enrollments, total plan costs and costs 

to employees. This survey will be 

conducted for AHRQ by the Bureau of 

the Census using an annual sample of 

employers selected from Census Bureau 

lists of private sector employers and 

governments. 

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