[Federal Register Volume 74, Number 139 (Wednesday, July 22, 2009)]
[Notices]
[Pages 36232-36235]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-17203]


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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: ``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. This 
proposed information collection was previously published in the Federal 
Register on September 3rd, 2008 and allowed 60 days for public comment. 
No comments were 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 responses has been 
decreased from 6,000 to 4,950, (2) the burden hours are decreased from 
838 to 709, and (3) the descriptions of each experimental arm in the 
sections: Clinician Choice Experimental Design and Health Plan Choice 
Experimental Design were removed.

DATES: Comments on this notice must be received by August 21, 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#327d7b60736d4147505f5b41415b5d5c725d5f501c575d421c555d44"><span class="__cf_email__" data-cfemail="bbf4f2e9fae4c8ced9d6d2c8c8d2d4d5fbd4d6d995ded4cb95dcd4cd">[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#bbdfd4c9d2c895d7deddd0d4ccd2cfc1fbdad3c9ca95d3d3c895dcd4cd"><span class="__cf_email__" data-cfemail="86e2e9f4eff5a8eae3e0ede9f1eff2fcc6e7eef4f7a8eeeef5a8e1e9f0">[email protected]</span></a>.

SUPPLEMENTARY INFORMATION: 

Proposed Project

``Study of Factors Influencing Consumer Choices Among Health Plans and 
Clinicians''

    AHRQ proposes to use an experimental design to determine factors 
that influence consumers' understanding and use of performance 
information to select among health plans and clinicians. The 
experimental design 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. For both 
the health plan and clinician choice experiments respondents will be 
randomly assigned to one of six experimental arms that vary according 
to the type and complexity of performance information

[[Page 36233]]

and the size of the choice set (number of plans or doctors) included in 
the Web-based report. Respondents will complete the experiment through 
a secure online connection from their homes. Data will be derived from 
pre and post-test questionnaires and from server logs that record the 
web pages visited and viewing times.
    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. This study, funded through 
cooperative agreements with the RAND Corporation and Harvard 
University, 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)(l), 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. The experimental designs 
of the clinician choice experiment and of the health plan choice 
experiment are discussed separately below.

Clinician Choice Experimental Design

    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 geographic area. Participants can 
click on hyperlinks or a tab to see more detailed results. The six 
experimental arms differ in the type and amount of performance 
information presented and the number of doctors listed.
    The goals of the experiment are to assess the process of consumer 
choice and the extent to which the Consumer Assessment of Healthcare 
Providers and Systems (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 across experimental arms.

Health Plan Choice Experimental Design

    The basic design of the health plan choice experiment is similar to 
that used for the clinician choice experiment. The key difference in 
the choice set is that as is true in real-world choices health plan 
choice is made complex in the experiment by introducing a larger number 
of measures of performance, compared to those available to inform 
clinician choice. Even the simplest experimental arm has twice as many 
component measures for health plans as for clinicians. Reports from 
consumers include both anecdotes and a count of aggregate complaints 
that have been filed against the plan.
    Potentially offsetting the cognitive burdens caused by additional 
measures, health plan choices typically involve fewer options than do 
clinician choices; in this choice experiment participants will face 
choice sets involving either 4 or 8 health plans.
    A second substantial difference exists between the health plan and 
clinician choice experiments: the former assesses in an explicit manner 
the ways in which emotionality affects how consumers make use of 
information. It will do so in two ways. First, the counts of complaints 
mentioned above as an additional measure of plan performance represent 
a quantitative score with a stronger emotional valence than the other 
measures. Second, two of the experimental arms will ``prime'' 
respondents to think about health outcomes in a more emotionally laden 
manner, to see if this alters the way in which they process this 
information.
    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 health plan quality, including customer services and 
accessibility of care issues, selected Healthcare Effectiveness Data 
and Information Set (HEDIS) measures for preventive care and treatment 
of chronic conditions, and selected reports on enrollee complaint rates 
and other issues. 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 across experimental arms.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
respondents' time to participate in this one year experiment. All 
participants will complete the pre-test, which is estimated to require 
5 minutes. As explained above, the experimental website varies by 
experimental arm; however, based on preliminary testing, each 
participant will require an average of 10 minutes to review the 
information on the site. The post-test questionnaires will require 
between 7 to 14 minutes to complete, depending on the experimental arm. 
The total burden hours are estimated to be 709 hours.
    Exhibit 2 shows the respondents' cost burden associated with their 
time to participate in this experiment. The total cost burden is 
estimated to be $13,887.

                                  Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
                                                                     Number of
               Experimental group                    Number of     responses per     Hours per     Total burden
                                                     responses      respondent       response          hours
----------------------------------------------------------------------------------------------------------------
Clinician Choice Experiment: Pretest                         750               1            5/60              63
    Experimental Web site.......................             750               1           10/60             125
    Baseline/Control Arm Post-test..............             125               1            7/60              15
    Experimental Arm <greek-i>1 Post-test.......             125               1            8/60              17
    Experimental Arm <greek-i>2 Post-test.......             125               1            8/60              17
    Experimental Arm <greek-i>3 Post-test.......             125               1           12/60              25
    Experimental Arm <greek-i>4 Post-test.......             125               1           12/60              25
    Experimental Arm <greek-i>5 Post-test.......             125               1           14/60              29
Health Plan Choice Experiment: Pretest                       900               1            5/60              75
    Experimental Web site.......................             900               1           10/60             150

[[Page 36234]]

 
    Baseline/Control Arm Post-test..............             150               1            7/60              18
    Experimental Arm <greek-i>1 Post-test.......             150               1            8/60              20
    Experimental Arm <greek-i>2 Post-test.......             150               1           12/60              30
    Experimental Arm <greek-i>3 Post-test.......             150               1           12/60              30
    Experimental Arm <greek-i>4 Post-test.......             150               1           14/60              35
    Experimental Arm <greek-i>5 Post-test.......             150               1           14/60              35
                                                 ---------------------------------------------------------------
        Total...................................           4,950              na              na             709
----------------------------------------------------------------------------------------------------------------


                                   Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
                                                     Number of     Total burden   Average hourly    Total cost
               Experimental group                   respondents        hours        wage rate*        burden
----------------------------------------------------------------------------------------------------------------
Clinician Choice Experiment: Pretest                         750              63          $19.56          $1,232
    Experimental Web site.......................             750             125           19.56           2,445
    Baseline/Control Arm Post-test..............             125              15           19.56             293
    Experimental Arm <greek-i>1 Post-test.......             125              17           19.56             333
    Experimental Arm <greek-i>2 Post-test.......             125              17           19.56             333
    Experimental Arm <greek-i>3 Post-test.......             125              25           19.56             489
    Experimental Arm <greek-i>4 Post-test.......             125              25           19.56             489
    Experimental Arm <greek-i>5 Post-test.......             125              29           19.56             567
Health Plan Choice Experiment: Pretest                       900              75           19.56           1,467
    Experimental Web site.......................             900             150           19.56           2,934
    Baseline/Control Arm Post-test..............             150              18           19.56             352
    Experimental Arm <greek-i>1 Post-test.......             150              20           19.56             391
    Experimental Arm <greek-i>2 Post-test.......             150              30           19.56             587
    Experimental Arm <greek-i>3 Post-test.......             150              30           19.56             587
    Experimental Arm <greek-i>4 Post-test.......             150              35           19.56             685
    Experimental Arm <greek-i>5 Post-test.......             150              35           19.56             685
                                                 ---------------------------------------------------------------
        Total...................................           4,950             709              na          13,887
----------------------------------------------------------------------------------------------------------------
*Based upon the mean of 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

    Exhibit 3 shows the total and annualized cost for developing and 
conducting both the health plan and clinician choice components of this 
study, including the cost of designing the experiments, developing the 
simulated Web-based reports, conducting usability testing of the Web 
reports, pilot testing the experiment, collecting the data, analyzing 
the data, preparing reports and papers for journal submission, and the 
cost for AHRQ staff to oversee the project. The total and annual costs 
are identical since data collection will not exceed one year. The total 
cost is estimated to be $844,000.

                  Exhibit 3--Total and Annualized Costs
------------------------------------------------------------------------
             Cost components                Total cost      Annual cost
------------------------------------------------------------------------
Experimental design.....................        $168,900        $168,900
Development of simulated Web-based               157,900         157,900
 reports................................
Pilot testing...........................          56,000          56,000
Usability testing of Web-based reports..          56,300          56,300
Data collection via Knowledge Networks..         126,000         126,000
Data analysis...........................          56,300          56,300
Preparation of reports and journal               112,600         112,600
 papers.................................
AHRQ project management.................         110,000         110,000
                                         -------------------------------
    Total...............................         844,000         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

[[Page 36235]]

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: July 8, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9-17203 Filed 7-21-09; 8:45 am]
BILLING CODE 4160-90-M


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