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 Department of Health and Human Services Agency for Healthcare Research and Quality
 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. 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 
                        *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 “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 
                    ( print 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
Experimental group
Number of
                             responses
Number of
                             responses per respondent
Hours per
                             response
Total burden hoursClinician Choice Experiment: Pretest
750
1
5/60
63Experimental Web site
750
1
10/60
125Baseline/Control Arm Post-test
125
1
7/60
15Experimental Arm #1 Post-test
125
1
8/60
17Experimental Arm #2 Post-test
125
1
8/60
17Experimental Arm #3 Post-test
125
1
12/60
25Experimental Arm #4 Post-test
125
1
12/60
25Experimental Arm #5 Post-test
125
1
14/60
29Health Plan Choice Experiment: Pretest
900
1
5/60
75Experimental Web site
900
1
10/60
150( print page 36234)Baseline/Control Arm Post-test
150
1
7/60
18Experimental Arm #1 Post-test
150
1
8/60
20Experimental Arm #2 Post-test
150
1
12/60
30Experimental Arm #3 Post-test
150
1
12/60
30Experimental Arm #4 Post-test
150
1
14/60
35Experimental Arm #5 Post-test
150
1
14/60
35Total
4,950
na
na
709
 Exhibit 2—Estimated Annualized Cost Burden
Experimental group
Number of 
                             respondents
Total burden hours
Average hourly wage rate*
Total cost 
                             burdenClinician Choice Experiment: Pretest
750
63
$19.56
$1,232Experimental Web site
750
125
19.56
2,445Baseline/Control Arm Post-test
125
15
19.56
293Experimental Arm #1 Post-test
125
17
19.56
333Experimental Arm #2 Post-test
125
17
19.56
333Experimental Arm #3 Post-test
125
25
19.56
489Experimental Arm #4 Post-test
125
25
19.56
489Experimental Arm #5 Post-test
125
29
19.56
567Health Plan Choice Experiment: Pretest
900
75
19.56
1,467Experimental Web site
900
150
19.56
2,934Baseline/Control Arm Post-test
150
18
19.56
352Experimental Arm #1 Post-test
150
20
19.56
391Experimental Arm #2 Post-test
150
30
19.56
587Experimental Arm #3 Post-test
150
30
19.56
587Experimental Arm #4 Post-test
150
35
19.56
685Experimental Arm #5 Post-test
150
35
19.56
685Total
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 costExperimental design
$168,900
$168,900Development of simulated Web-based reports
157,900
157,900Pilot testing
56,000
56,000Usability testing of Web-based reports
56,300
56,300Data collection via Knowledge Networks
126,000
126,000Data analysis
56,300
56,300Preparation of reports and journal papers
112,600
112,600AHRQ project management
110,000
110,000Total
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 
                    ( print 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