[Federal Register Volume 74, Number 114 (Tuesday, June 16, 2009)]
[Notices]
[Pages 28502-28504]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-14080]
-----------------------------------------------------------------------
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 [email protected] (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
[email protected].
SUPPLEMENTARY INFORMATION:
Proposed Project
``CAHPS Field Test of Proposed Health Information Technology Questions
and Methodology''
The Consumer Assessment of Healthcare Providers and Systems
(CAHPS[reg]) 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[reg] 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[reg] 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[reg] 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
[[Page 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[reg] 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[reg] 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[reg] 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
----------------------------------------------------------------------------------------------------------------
Number of
Form Name Number of responses per Hours per Total burden
respondents respondent response hours
----------------------------------------------------------------------------------------------------------------
CAHPS[reg] Clinician & Group Survey, Adult 7,200 1 20/60 2,400
Primary Care Questionnaire.....................
---------------------------------------------------------------
Total....................................... 7,200 1 na 2,400
----------------------------------------------------------------------------------------------------------------
Exhibit 2. Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
Number of Total burden Average hourly Total cost
Form Name respondents hours wage rate* burden
----------------------------------------------------------------------------------------------------------------
CAHPS[reg] Clinician & Group Survey, Adult 7,200 2,400 $19.56 $46,944
Primary Care Questionnaire.....................
---------------------------------------------------------------
[[Page 28504]]
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[reg] 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
------------------------------------------------------------------------
Total
Cost component 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