[Federal Register Volume 70, Number 53 (Monday, March 21, 2005)]
[Notices]
[Pages 13504-13506]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-5436]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Request for Measures of Healthcare Experiences of People With 
Mobility Impairment

AGENCY: Agency for Healthcare Research and Quality (AHRQ), DHHS.

ACTION: Notice of request for measures.

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SUMMARY: The Agency for Healthcare Research and Quality (AHRQ), with 
the support of the Centers for Disease Control and Prevention (CDC) of 
the U.S. Department of Health and Human Services and the National 
Institute on Disability and Rehabilitation Research (NIDRR) of the U.S. 
Department of Education are soliciting the submission of instruments or 
items that measure the quality of healthcare experienced by people with 
mobility impairment. The instruments or items will be considered for 
inclusion in a CAHPS[reg] survey of people with mobility impairment 
(PWMI). Items or survey instruments may be submitted from researchers, 
health plans, other health care providers, disability organizations, 
stakeholders, vendors and other interested parties. This initiative is 
in response to suggestions from a significant number of stakeholders to 
develop a CAHPS[reg] tool that measures the quality of care as 
perceived by adults with disabilities, and to provide performance data 
to health plans and others that are actionable for quality improvement 
and access. Our response to stakeholder requests will ultimately 
provide users with a flexible survey tool to assess the quality of 
healthcare services for adults with disabilities across multiple 
settings. The focus of this initial project will be only on people with 
mobility impairments, and subsequent survey projects may focus on other 
aspects of disability.
    Many questions in the existing CAHPS instruments address concerns 
of people with mobility impairments, including access, communication, 
courtesy and respect, and shared decision-making. We are particularly 
interested in identifying and considering new content areas, new 
response categories and scales for existing questions, and revised 
wording or question order to make existing questions disability-
appropriate.

DATES: Please submit instruments or items and supporting information on 
or before May 20, 2005. AHRQ will not respond individually to 
submitters, but will consider all submitted instruments and items, and 
publicly report the results of the review of the submissions in 
aggregate.

ADDRESSES: Submissions should include a brief cover letter, a copy of 
an instrument or items for consideration, and supporting statements and 
information as specified under the submission criteria below. 
Submissions may be in the form of a letter or e-mail, preferably as an 
electronic file with an e-mail attachment. Electronic submissions are 
strongly encouraged. Responses to this request should be submitted to: 
Marybeth Farquhar, RN, MSN, Agency for Healthcare Research and Quality, 
540 Gaither Road, Rockville, MD 20850, phone: (301) 427-1317, Fax: 
(301) 427-1341, e-mail: [email protected].
    To facilitate handling of submissions, please include full-
information about

[[Page 13505]]

the instrument developer or contact person: (a) Name, (b) title, (c) 
organization, (d) mailing address, (e) telephone number, (f) fax 
number, and (g) e-mail address. Also, please submit with a copy of the 
instrument or items for consideration, evidence that it/they meet(s) 
the criteria set out under the Submission Criteria section below. 
Please do not use acronyms in your submissions.
    Submitters musts also provide a statement of willingness to grant 
to AHRQ the right to use and authorize others to use submitted measures 
and their documentation as part of a new or revised CAHPS[reg]-
trademarked instrument. The new CAHPS[reg] instrument for people with 
mobility impairments will be made publicly available, free of charge.

FOR FURTHER INFORMATION CONTACT: Marybeth Farquhar, RN, MSN, Center for 
Quality Improvement and Patient Safety, Agency for Healthcare Research 
and Quality, 540 Gaither Road, Rockville, MD 20850; phone (301) 427-
1317; Fax: (301) 427-1341; e-mail: [email protected].

Submission Criteria

    Instruments submitted should focus on health care for the functions 
listed below, as well as any other quality domains that are indicated 
by the field to be important for people with mobility impairments. The 
following are provided as examples of areas of interest; however, items 
or tools reflecting additional domains are also welcome.
     Care coordination between providers or sites of care for 
people with mobility impairments;
     Shared decision-making or consumer involvement in 
decision-making about health care options and treatment.
     Culturally appropriate and disability sensitive care or 
care that tries to meet the cultural and linguistic needs of consumers 
including those using augmentative communication devices.
     Availability of information from the health plan in 
suitable alternative formats to promote consumer decision-making about 
health care options, treatment and access;
     Availability and usability of plan-level information in 
alternative formats on benefits, coverage, out-of-pocket cost to 
consumers, and how to file grievances/appeals;
     Availability and usability of consumer information from 
the health plan that identifies and compares accessible and disability-
literate providers;
     Availability and usability of consumer information from 
the health plan to assist consumers in the selection of individual 
clinician (primary care or specialist) or treatment programs (e.g., 
pain management, skin breakdown clinics, or condition-sepcific clinics 
such as multiple sclerosis or post-polio); and,
     Helpfulness of health plan call center staff and customer 
service staff.
    Measures submitted should meet these criteria to be considered: 
Capture the quality of care as experienced by people with mobility 
impairments; demonstrate a high degree of reliability and validity 
across different conditions leading to different degrees of mobility 
impairment; and have been used widely, not just in one or two research 
studies.
    Submitter's willingness to grant to AHRQ the right to use and 
authorize others to use the instrument means that the CAHPS[reg] 
trademark will be applied to a new instrument combining the best 
features of all the submissions as well as any ideas that may be 
developed in the course of reviewing them. Free access to any final 
CAHPS instrument(s) for people with mobility impairment, and free 
access to the instrument's supportive/administrative information is 
important to permit widespread use of a uniform tool. Thus, submitters 
of items that may be incorporated in the new CAHPS-PWMI supplement will 
be required to permit such universal free access to and use of, their 
incorporated item(s). However, item ownership will be protected during 
testing of the new CAHPS-PWMI surveys. AHRQ, in collaboration with 
NIDRR, CDC, and the expert CAHPS grantees, will evaluate all submitted 
instruments or items, and select one or more either in whole or in part 
for testing and, if required, modification. AHRQ will assume 
responsibility for the final instruments as well as any future 
modifications.
    The final instruments will bear the CAHPS[reg] trademark and they 
will be made freely available for use by all interested parties. 
Submitters will relinquish exclusive control of any items that appear 
in the final instrument. As a matter of quality control there will be 
warnings that CAHPS[reg] identification may not be used if any changes 
are made to the instrument or final measure set without review and 
permission of the Agency.
    Each submission should include the following information:
     The name of the instrument;
     Whether the instrument/item(s) is disease or condition 
specific;
     Domain(s) of the instrument/items;
     Language(s) in which the instrument/item(s) is available;
     Evidence of cultural/cross group comparability, if any;
     Instrument reliability (internal consistency, test-retest, 
etc.);
     Validity (content, construct, criterion-related);
     Response rates;
     Methods and results of cognitive testing and field-
testing;
     Description of sampling strategies and data collection 
protocols, including such elements as mode of administration, use of 
advance letters, timing and frequencies of contacts;
     A list of where the instrument has been fielded and at 
what level it has been and/or is being used; and
     Evidence addressing the criteria should be demonstrated 
through submission of peer-reviewed journal article(s) or through the 
best evidence available at the time of submission. Citation of peer-
reviewed journal article(s) pertaining to the instrument or item(s) 
include the title of the article, author(s), publication year, journal 
name, volume, issue, and page numbers where article appears, may be 
included but are not required.
    Submission of copies of existing report formats developed to 
provide findings to consumers and providers is desirable, but not 
required. Additionally, information about existing database(s) for the 
instrument(s) submitted is helpful, but also not required for 
submission.

SUPPLEMENTARY INFORMATION:

Background

    Public and private organizations are surveying consumers to collect 
information on access to care, use of health services, health outcomes, 
and patient satisfaction. The results of these surveys are being used 
by: Consumers to inform their choices about health care plans; 
purchasers to assess the value of the services they buy; and health 
insurers, quality managers and policy makers, to plan programs and 
services. The original CAHPS Request for Applications (RFA) broadly 
defined the future direction of the CAHPS initiative including the 
development of a core health plan survey and additional modules to 
obtain assessment data from a variety of consumers including high users 
of health care services, such as the chronically ill, those suffering 
severe acute episodes of illness, and persons with disabilities.
    Rationale for developing a CAHPS-PWMI includes:
     Persons with disabilities on average need both more health 
services as well as more complex services than persons

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without disabilities. It is important for providers, payers, purchasers 
and other stakeholders to understand what these needs are so that they 
can be met more appropriately.
     Information about health plan and health care deficits ins 
an important step in quality improvement for all consumers. Because 
they are on average higher users of care and often use a large variety 
of services, persons with mobility impairments are likely to identify 
important plan deficits that may be evident to consumers without 
disabilities.
     More persons with mobility impairments are being offered 
complex choices about both health plan options and health care quality.
    In CAHPS II, we are focusing on a single type of impairment, 
specifically mobility impairments, which can be used as a starting 
point for development. We define ``mobility impairment'' as a 
functional impairment of the lower limbs. Some health care needs of 
people with and without mobility impairments are similar; for example, 
everyone needs preventive screening services and counseling about 
healthy behaviors. Mobility impairments severe enough to require an 
assistive device usually stem from a condition requiring additional 
preventive and specialized health care needs such as examining tables 
that can be adjusted for easy transfer, and accessible diagnostic 
equipment and rest rooms. The mobility impairment may be accompanied by 
upper limb mobility impairments, chronic pain, impaired cognition, and/
or behavioral co-impairments such as anxiety or depression. 
Consequently even though initially we are directly addressing the 
specific needs of people with mobility impairments, we will also be 
indirectly addressing the needs of people with other types of 
impairments.

    Dated: March 10, 2005.
Carolyn M. Clancy,
Director.
[FR Doc. 05-5436 Filed 3-18-05; 8:45 am]
BILLING CODE 4160-90-M