[Federal Register Volume 73, Number 171 (Wednesday, September 3, 2008)]
[Notices]
[Pages 51484-51487]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-20315]


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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.

DATES: Comments on this notice must be received by November 3, 2008.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by email at 
[email protected].
    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 
[email protected].

SUPPLEMENTARY INFORMATION:

Proposed Project

    ``Study of Factors Influencing Consumer Choices Among Health Plans 
and Clinicians''
    This study will use an experimental design to determine factors 
that influence consumer understanding and use of performance 
information to select among health plans and clinicians. Performance 
reports on health plans and individual providers have become 
increasingly available in recent years, but there is little evidence 
regarding how consumers understand and use different types of 
performance information to make choices.
    The study 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. Both 
experiments will present a panel of online consumers with a simulated 
Web-based performance report. Study subjects will answer a series of 
pre-test questions, and then be directed to a Web site with a simulated 
report (for either health plans or doctors) where they will view 
various types of performance information, go through the process of 
selecting either a health plan or a doctor, and then complete the 
experiment by answering a series of post-test questions about how they 
made their selection.
    The categories of performance information to be included in the Web 
reports will be derived from patient experience survey results using 
Consumer Assessment of Healthcare Providers and Systems (CAHPS) 
composite measures, clinical process measures, personal anecdotes based 
on patient or enrollee experiences, and the frequency of different 
types of enrollee complaints or grievances (in the plan experiment 
only).
    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. The simulated Web-based reports 
will be made available as examples for other report developers to use. 
This study 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)(1), 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. For both the health plan 
and clinician choice experiments, study subjects will be randomly 
assigned to one of several arms (described below)

[[Page 51485]]

that vary according to the type and complexity of performance 
information and the size of the choice set (number of plans or doctors) 
included in the Web report. Participants will complete the experiment 
through a secure online connection from their homes.

Clinician Choice Experimental Design

    In each of the six arms, study 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 zip code 
area. Participants can click on hyperlinks or a tab to see more 
detailed results. The experimental arms differ in the type and amount 
of performance information presented and the number of doctors listed, 
as described below:
    (1) Baseline/Control Arm: participants see only ``Patient Survey 
Results'' for each of 12 doctors in this arm. This includes a summary 
measure on the Performance Overview page and more detailed measures 
corresponding to CAHPS composites and an overall doctor rating on the 
drill-down page.
    (2) Experimental Arm #1: Augmented Quantified Performance Measures: 
In this arm participants will also see ``Patient Survey Results'' on 12 
doctors. In addition, they will see a summary clinical performance 
measure labeled ``Medical Quality Scores.'' The drill-down page shows 
that this is based on clinical indicators for prevention and screening, 
care for asthma, care for diabetes, and care for heart disease.
    (3) Experimental Arm #2: CAHPS plus Anecdotes: In this arm, 
participants will again be presented with ``Patient Survey Results'' on 
12 doctors. In addition, for each doctor, they will see a tab labeled 
``Patient Comments.'' By clicking on this tab, they can see from four 
to six patient comments describing patients' experiences with each 
doctor. Participants in this arm will not see clinical performance 
scores.
    (4) Experimental Arm #3: Augmented Quantified Performance Measures 
Plus Anecdotes: In this arm participants will be presented with all 
three types of information on 12 doctors: ``Patient Survey Results,'' 
``Medical Quality Scores'', and ``Patient Comments.''
    (5) Experimental Arm #4: CAHPS plus Anecdotes and Larger Choice 
Set: In this arm participants will be presented with ``Patient Survey 
Results'' and ``Patient Comments'' on 24 doctors.
    (6) Experimental Arm #5: Maximum Cognitive Load: Large Choice Set 
and Three Measures of Performance: In this arm, participants are 
presented with all three types of information on 24 doctors: ``Patient 
Survey Results,'' ``Medical Quality Scores,'' and ``Patient Comments.''
    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 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 somewhat across experimental arms.

Health Plan Choice Experimental Design

    The design of the health plan choice experiment has a comparable 
architecture to the clinician-choice experiment, but makes choices more 
challenging by adding more dimensions of performance measures within a 
smaller choice set. (These distinctions between informed clinician 
choice and informed plan choice replicate the information currently 
available to consumers over the internet.) In each of the six arms, 
study participants will see a web page labeled ``Performance Overview'' 
that presents performance information for a set of health plans in a 
way that allows them to compare plan ratings. Performance is summarized 
by assigning one to five stars to show how each plan compares with 
others in the same community. Participants can click on hyperlinks or a 
tab to see more detailed results. The experimental arms differ in the 
type and amount of performance information presented and the number of 
plans listed, as described below:
    (1) Baseline/Control Arm: participants see only ``Patient Survey 
Results'' for each of 4 plans in this arm. This includes a summary 
measure on the Performance Overview page and more detailed measures 
corresponding to CAHPS composites and an overall plan ratings on the 
drill-down page.
    (2) Experimental Arm #1: Augmented Quantified Performance Measures: 
In this arm participants will also see ``Patient Survey Results'' on 
four plans. In addition, they will see two summary clinical performance 
measures labeled ``Health Care Quality Scores,'' which will consist of 
selected Health Care Effectiveness Data and Information Set (HEDIS) 
measures, one for preventive care, and one for the treatment of chronic 
conditions. The drill-down page for prevention will show preventive 
care scores of regular physical exams, and screening for three common 
medical conditions. The drill down page for treatment will include 
summary measures for heart problems, asthma, diabetes, and arthritis. A 
summary score for the reported rate of consumer complaints will also be 
included, with a drill down reporting rating for the four most common 
causes of complaints, with the categories based on actual data from 
three states.
    (3) Experimental Arm #2: CAHPS plus Anecdotes: In this arm, 
participants will again be presented with ``Patient Survey Results'' on 
four plans. In addition, for each plan, they will see a tab labeled 
``Patient Comments.'' By clicking on this tab, they can see from four 
to six patient comments describing patients' experiences with each 
plan. Participants in this arm will not see quality performance or 
rates of patient complaints scores.
    (4) Experimental Arm #3: Augmented Quantified Performance Measures 
Plus Anecdotes: In this arm participants will be presented with all 
four types of information for four plans: ``Patient Survey Results,'' 
``Health Care Quality Scores'', ``Patient Complaint Rates'' and 
``Patient Comments.''
    (5) Experimental Arm #4: CAHPS plus Anecdotes and Larger Choice 
Set: In this arm participants will be presented with ``Patient Survey 
Results'' and ``Patient Comments'' on 12 plans.
    (6) Experimental Arm #5: Maximum Cognitive Load: Large Choice Set 
and Five Measures of Performance: In this arm, participants are 
presented with all three types of information: ``Patient Survey 
Results,'' ``Health Care Quality Scores'' (both prevention and 
treatment), ``Patient Complaint Rates'' and ``Patient Comments'' on 12 
plans.
    The goal of these experiments is 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 plan performance, including quantitative patient experience 
measures, anecdotal reports from individual patients, frequency of 
consumer complaints, 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 
somewhat across experimental arms.

[[Page 51486]]

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
respondents' time to participate in this experiment. This experiment 
will not exceed one year. All participants will complete the pre-test 
which is estimated to require 5 minutes. As explained above, the 
experimental Web site varies by experimental arm, however, each 
participant is expected to require about 10 minutes to review the 
information on the site. The baseline/control post-test will be 
completed by 170 participants and will require about 7 minutes to 
complete. Both the experimental arm 1 and 2 post-test 
will be completed by 166 participants each and will take about 8 
minutes. Both the experimental arm 3 and 4 post-test 
will be completed by 166 participants each and will require about 12 
minutes to complete. The experimental arm 6 post-test will be 
completed by 166 participants and will require about 14 minutes to 
complete. The total burden hours are estimated to be 838 hours.
    Exhibit 2 shows the respondents' cost burden for their time to 
participate in this experiment. The total cost burden is estimated to 
be $16,142.

                                  Exhibit 1--Estimated Annualized Burden Hours
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                                                                     Number of
               Experimental group                    Number of     responses per     Hours per     Total burden
                                                     responses      respondent       response          hours
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Clinician Choice Experiment:
    Pretest.....................................           1,000               1            5/60              83
    Experimental Web site.......................           1,000               1           10/60             167
    Baseline/Control Post-test..................             170               1            7/60              20
    Experimental Arm 1 Post-test.......             166               1            8/60              22
    Experimental Arm 2 Post-test.......             166               1            8/60              22
    Experimental Arm 3 Post-test.......             166               1           12/60              33
    Experimental Arm 4 Post-test.......             166               1           12/60              33
    Experimental Arm 5 Post-test.......             166               1           14/60              39
Health Plan Choice Experiment:
    Pretest.....................................           1,000               1            5/60              83
    Experimental Web site.......................           1,000               1           10/60             167
    Baseline/Control Post-test..................             170               1            7/60              20
    Experimental Arm 1 Post-test.......             166               1            8/60              22
    Experimental Arm 2 Post-test.......             166               1            8/60              22
    Experimental Arm 3 Post-test.......             166               1           12/60              33
    Experimental Arm 4 Post-test.......             166               1           12/60              33
    Experimental Arm 5 Post-test.......             166               1           14/60              39
                                                 ---------------------------------------------------------------
        Total...................................           6,000              na              na             838
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                                   Exhibit 2--Estimated Annualized Cost Burden
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                                                     Number of     Total burden   Average hourly    Total cost
               Experimental group                    responses         hours        wage rate*        burden
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Clinician Choice Experiment:
    Pretest.....................................           1,000              83          $19.26          $1,599
    Experimental Web site.......................           1,000             167           19.26           3,216
    Baseline/Control Post-test..................             170              20           19.26             385
    Experimental Arm 1 Post-test.......             166              22           19.26             424
    Experimental Arm 2 Post-test.......             166              22           19.26             424
    Experimental Arm 3 Post-test.......             166              33           19.26             636
    Experimental Arm 4 Post-test.......             166              33           19.26             636
    Experimental Arm 5 Post-test.......             166              39           19.26             751
Health Plan Choice Experiment:
    Pretest.....................................           1,000              83           19.26           1,599
    Experimental Web site.......................           1,000             167           19.26           3,216
    Baseline/Control Post-test..................             170              20           19.26             385
    Experimental Arm 1 Post-test.......             166              22           19.26             424
    Experimental Arm 2 Post-test.......             166              22           19.26             424
    Experimental Arm 3 Post-test.......             166              33           19.26             636
    Experimental Arm 4 Post-test.......             166              33           19.26             636
    Experimental Arm 5 Post-test.......             166              39           19.26             751
                                                 ---------------------------------------------------------------
        Total...................................           6,000             838              na         16,142
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*Based upon the mean of the average wages, National Compensation Survey: Occupational wages in the United States
  2006, ``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 and 
conducting both the health plan and clinician choice components of this 
study is $844,000, 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

[[Page 51487]]

to oversee the project; see Exhibit 3. The annualized cost for this two 
year project is $422,000.

                   Exhibit 3--Project Cost Components
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                                                                 Cost
                       Cost components                         estimate
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Experimental design.........................................    $168,900
Development of simulated Web-based reports..................     157,900
Pilot testing...............................................      56,000
Usability testing of Web-based reports......................      56,300
Data collection via Knowledge Networks......................     126,000
Data analysis...............................................      56,300
Preparation of reports and journal papers...................     112,600
    AHRQ project management.................................     110,000
                                                             -----------
    Total...................................................     844,000
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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 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: August 26, 2008.
Carolyn M. Clancy,
Director.
[FR Doc. E8-20315 Filed 9-2-08; 8:45 am]
BILLING CODE 4160-90-M