[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]


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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: ``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
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                                                                     Number of
                    Form Name                        Number of     responses per     Hours per     Total burden
                                                    respondents     respondent       response          hours
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CAHPS[reg] Clinician & Group Survey, Adult                 7,200               1           20/60           2,400
 Primary Care Questionnaire.....................
                                                 ---------------------------------------------------------------
    Total.......................................           7,200               1              na           2,400
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                                   Exhibit 2. Estimated Annualized Cost Burden
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                                                     Number of     Total burden   Average hourly    Total cost
                    Form Name                       respondents        hours        wage rate*        burden
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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
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*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
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                                                                 Total
                        Cost component                            cost
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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
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    Total....................................................    780,000
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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: June 4, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9-14080 Filed 6-15-09; 8:45 am]
BILLING CODE 4160-90-P