[Federal Register Volume 74, Number 139 (Wednesday, July 22, 2009)]
[Notices]
[Pages 36235-36237]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-17201]


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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: ``Health Literacy Item Set Supplemental to CAHPS Hospital 
Survey--Pretest of Proposed 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 May 13th, 2009 and allowed 60 days for public 
comment. 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 burden hours are increased from 200 to 250, and 
(2) an incentive experiment has been added.

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 [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

``Health Literacy Item Set Supplemental to CAHPS Hospital Survey--
Pretest of Proposed Questions and Methodology''

    AHRQ proposes to conduct a pretest of the Consumer Assessment of 
Healthcare Providers and Systems (CAHPS[reg]) Hospital Survey health 
literacy module. The CAHPS 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 to 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 to meet the 
various needs of health care consumers, purchasers, health plans, 
providers, and policymakers. Based on a literature review and an 
assessment of currently available questionnaires, AHRQ identified the 
need to develop a health literacy module for the CAHPS[reg] Hospital 
Survey. The intent of the planned module is to examine patients' 
perspectives on how well health information is communicated to them by 
healthcare professionals in the hospital setting. The objective of the 
new module is to provide information to health plans, hospitals, 
clinicians, group practices, and other interested parties regarding the 
quality of health information delivered to patients. The set of 
questions about health literacy will be evaluated as a supplement to 
the CAHPS[reg] Hospital Survey.
    This study will be conducted for AHRQ by its contractor, RAND 
Corporation. It 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. See 42 U.S.C. 299a(a)(1).
    This study is a one-time field test to be completed in the calendar 
years 2009 and 2010. The field test to be conducted under this request 
will be done for the following purposes:
    a. Analysis of item wording--Assess candidate wordings for items.
    b. Analysis of participation rate--Evaluate the overall response 
rate and the proportion of that obtained from mail versus telephone 
modes of data collection.
    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 of 
the health literacy item set based on the assessment of the reliability 
and validity.
    e. 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 collection of the data related to the 
assessment of patients' perspective on how well health information is 
communicated to them by health care professionals in a hospital 
setting. The field testing will ensure that future data collections 
yield high quality data and minimize 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 
enhance the ability of hospitals to assess the quality of their 
services.

Method of Collection

    The potential respondent universe is persons who had at least one 
overnight stay at a hospital within the previous five months. Excluded 
from the study will be those who were less than 18 years old at the 
time of their admission, had a psychiatric diagnosis, were discharged 
to a hospice facility or died during the hospitalization. Testing sites 
will be selected purposively based on several considerations, including 
ability to execute the activities necessary to participate in the 
pilot, number of beds, number of discharges for medical, surgical, and 
obstetric patients, average length of stay, location (urban versus 
rural), profit status, and academic medical center status.
    The draw will be a sample large enough to yield approximately 600 
completes. It is assumed that

[[Page 36236]]

approximately 1,200 patients will be sampled across all field sites 
with a response rate of 50%. This pretest will use a mixed mail-
telephone mode of data collection which will include the following 
steps:
     Mailing an advanced notification letter.
     Mailing of the questionnaire and cover letter.
     Postcard reminder.
     A second mailing of the questionnaire to non-respondents.
     Up to 10 telephone calls to every mail non-respondent 
approximately two weeks after the final mailing.
    Every effort will be made to maximize the response rate, while 
retaining the voluntary nature of the effort. An advance notice will be 
mailed prior to mailing the survey and will include a letter explaining 
what the survey is about, who is doing it and why, and providing 
contact information for questions. The second mailing and telephone 
follow-up are expected to result in significant increases in response. 
Every effort to maximize the response rate among Spanish-speaking 
respondents will be made. A Spanish version of the advance notice, the 
questionnaire, cover letters, and the reminder card, as well as a 
Spanish version of the telephone transcript has been developed. The 
cover letters in English include a note in Spanish instructing 
respondents to call a toll free number if they would like to receive a 
copy of the survey in Spanish. In addition, participating field sites 
will ask for information on language preference and/or race/ethnicity 
of sample patients so that the mailing of the survey can be tailored 
for Spanish-speakers.
    Finally, phone follow-up to respondents who do not complete the 
survey by mail will be conducted by bilingual interviewers so that 
those who want to complete the survey by telephone in either English or 
Spanish can accommodated.
    Surveys generally do not yield complete responses from every 
individual sampled from the population. In this analysis, patterns of 
both unit and item nonresponse will be examined and modeled, and the 
potential impact of nonresponse bias assessed. A common set of 
administrative variables (e.g., age, gender, race/ethnicity) will be 
used to predict unit nonresponse. These variables and others collected 
on the survey itself will be used as predictors of item nonresponse. 
Case mix adjustment and nonresponse weights will be used to more 
accurately reflect consumer experiences with health care in the field 
test hospitals. Multivariate logistic regression models will be used to 
analyze the factors associated with unit nonresponse and item 
nonresponse.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden for the 
respondents' time to participate in this data collection. The CAHPS 
Hospital Survey Health Literacy Module will be completed by about 600 
persons. The estimated response time of 25 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 similar 
samples. The total burden hours are estimated to be 250 hours.
    Exhibit 2 shows the respondents' cost burden associated with their 
time to participate in this data collection. The total cost burden of 
completing pretest is estimated to be $4,890.

                                  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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Mail survey with reminder card, mail and phone               600               1           25/60             250
 follow-up......................................
                                                 ---------------------------------------------------------------
    Total.......................................             600               1              na             250
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                                  Exhibit 2--Estimated Annualized Burden Hours
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                                                     Number of     Total burden   Average hourly    Total cost
                    Form name                       respondents        hours        wage rate*        burden
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Mail survey with reminder card, mail and phone               600             250          $19.56          $4,890
 follow-up......................................
                                                 ---------------------------------------------------------------
    Total.......................................             600             250              na          4,890
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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 for the contracted service is approximately $245,000 
and the cost for AHRQ staff to oversee the project is $50,000, 
including benefits. The project was initiated in October of 2008 and it 
is forecasted that it will be completed in 18 months. The initial 
developmental work has been completed within the first ten months of 
the project and it is forecasted that the pretest, analysis and 
finalization of the Health Literacy Item Set supplemental to CAHPS 
Hospital Survey can be completed within the next eight months. It is 
estimated that the total cost of the project is approximately $295,000. 
The annualized cost of the project is approximately $196,669.

                        Exhibit 3--Estimated Cost
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                                                            Annualized
             Cost component                 Total cost         cost
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Review of literature....................         $20,000         $13,334
Cognitive interviews....................          60,000          40,000
Field test..............................          90,000          60,000

[[Page 36237]]

 
Data analyses...........................          40,000          26,667
Finalize survey.........................          35,000          23,334
AHRQ project management.................          50,000          33,334
                                         -------------------------------
    Total...............................         295,000         196,669
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Request for Comments

    In accordance with the above-cited Paperwork Reduction Act 
legislation, comments on AFIRQ'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: July 8, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9-17201 Filed 7-21-09; 8:45 am]
BILLING CODE 4160-90-M