[Federal Register Volume 77, Number 81 (Thursday, April 26, 2012)]
[Notices]
[Pages 24955-24957]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-10007]
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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: ``System Redesign for Value in Safety Net Hospitals and
Delivery Systems.'' In accordance with the Paperwork Reduction Act, 44
U.S.C. 3501-3521, AHRQ invites the public to comment on this proposed
information collection.
This proposed information collection was previously published in
the Federal Register on February 24th, 2012 and allowed 60 days for
public comment. No substantive comments were received. The purpose of
this notice is to allow an additional 30 days for public comment.
DATES: Comments on this notice must be received by May 29, 2012.
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
email 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 email at
[email protected].
SUPPLEMENTARY INFORMATION:
Proposed Project
System Redesign for Value in Safety Net Hospitals and Delivery Systems
This proposed project is a case study of 8 safety net (SN)
hospitals. The goals of the project are to:
(1) Identify the tools and resources needed to facilitate system
redesign in SN hospitals and;
(2) Identify any barriers to adoption of these in SN environments,
or any gaps that exist in the available resources.
These goals are consistent with The National Strategy for Quality
Improvement in Health Care, published by the U.S. Department of Health
and Human Services in March 2011, which articulated a need for progress
toward three goals: (1) Better Care, (2) Healthy People/Healthy
Communities and (3) Affordable Care. SN hospitals and systems are
critical to achieving all three. SN hospitals are hospitals and health
systems which provide a significant portion of their services to
vulnerable, uninsured and Medicare patients. While all hospitals face
challenges in improving both quality and operating efficiency, safety
net (SN) hospitals face even greater challenges due to growing demand
for their services and decreasing funding opportunities.
Despite these challenging environmental factors, some SN hospitals
and health systems have achieved financial stability and implemented
broad-ranging efforts to improve the quality of care they deliver.
However, while there have been successful quality improvement
initiatives for SN providers, most initiatives aim at specific units
within large organizations. The improvements introduced into these
units have not often been spread throughout the organization.
Additionally, these improvements often are hard to sustain. ``System
redesign'' refers to aligned and synergistic quality improvement
efforts across a hospital or health system leading to multidimensional
changes in the management or delivery of care or strategic alignment of
system changes with an organization's business strategy. System
redesign, if done successfully, will allow SN providers to improve
their operations, remain afloat financially, and provide better quality
healthcare to vulnerable and underserved populations. Resources, as
defined here, may include learning materials and environments developed
to support, advance, and facilitate quality improvement efforts (e.g.,
tools, guides, webinars, learning collaboratives, training programs).
The term ``resources'' should not be interpreted here to imply
financial support for routine staffing or operations of Safety Net
systems, but may include quality improvement grants, fellowships,
collaboratives and trainings.
Many tools, guides, and other learning environments have been
developed to support the implementation of individual quality
improvement initiatives. However, the development of resources to
support alignment across multiple domains of a health system has been
limited. Furthermore, the applicability of existing resources to SN
environments is unknown.
This study is being conducted by AHRQ through its contractor,
Boston University, pursuant to AHRQ's statutory authority to conduct
and support research on healthcare and on systems for the delivery of
such care, including activities with respect to the quality,
effectiveness, efficiency, appropriateness and value of healthcare
services and with respect to quality measurement and improvement. 42
U.S.C. 299a(a)(1) and (2).
Method of Collection
To achieve the goals of this project the following activities and
data collections will be implemented:
[[Page 24956]]
(1) In-person interviews will be conducted during a 2-day site
visit with senior medical center leaders, clinical managers and staff
involved in system redesign from each of the 8 participating SN
hospitals. These interviews may be conducted one-on-one or in small
groups, depending upon the participants' availability. The purpose of
these interviews is to learn directly from hospital leadership and
staff about the resources they have used to support and guide their
system redesign efforts and what, if any, gaps there are in the
resources available to them.
(2) Collection of documentation from each SN hospital. The
documentation to be collected includes annual reports, performance
dashboards, reports on specific system redesign and quality improvement
projects and hospital newsletters. The purpose of this task is to
provide supplementary information about the hospitals and their quality
improvement and system redesign efforts. Collection of documentation
from participating hospitals will allow the research team to collect
additional information that is readily available in hospital documents,
but may not be known or readily accessible to interview subjects during
their interviews.
The findings and recommendations developed from this project will
be disseminated through AHRQ networks and through our partnership with
the National Association of Public Hospitals and its membership group
to ensure that findings are reaching administrators at public and SN
hospitals directly. In addition, findings will be published in peer-
reviewed and trade literature so that they will be available to a wide
range of SN delivery system managers and clinicians for use in
hospitals and healthcare systems. Findings will be presented as
illustrative of the issues facing SN hospitals engaging in system
redesign--rather than as representing the quantity or distribution of
conditions and practices within SN hospitals. All presentations and
publications will state the limitations of our case-study methodology.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
respondents' time to participate in this data collection. In-person
interviews will be conducted with a total of 160 hospital staff members
(20 from each of the 8 participating SN hospitals) and will last about
1 hour. The collection of documentation will require 2 hours work from
1 staff member at each hospital. The total burden is estimated to be
176 hours.
Exhibit 1--Annualized Burden Hours
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Number of
Data collection Number of responses per Hours per Total burden
respondents respondent response hours
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In-person interviews............................ 160 1 1 160
Collection of documentation..................... 8 1 2 16
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Total....................................... 168 n/a n/a 176
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Exhibit 2 shows the estimated annualized cost burden associated
with the respondents' time to provide the requested data. The total
cost burden is estimated to be $9,242 annually.
Exhibit 2--Estimated Annualized Burden Cost
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Number of Total burden Average hourly Total cost
Data collection respondents hours wage rate * burden
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In-person interviews............................ 160 160 $56.23 $8,997
Collection of documentation..................... 8 16 15.30 245
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Total....................................... 168 176 na 9,242
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* The hourly rate of $56.23 is an average of the clinical personnel hourly wage of $91.10 for physicians and
$32.56 for registered nurses, and the administrative personnel hourly wage of $45.03 for medical and health
services managers. The hourly rate of $15.30 is median hourly rate for medical administrative support staff.
All hourly rates are based on median salary data provided by the U.S. Bureau of Labor Statistics.
Estimated Annual Costs to the Federal Government
Exhibit 3 shows the estimated total and annualized cost to the
government for this 3 year project. The total cost is $499,877 and
includes the cost of data collection, data analysis, reporting, and
government oversight of the contract. The costs associated with data
collection activities are not all for the primary data collection of
the case studies but include the review of existing literature and
other available data sources.
Table 3--Cost to the Federal Government
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Annualized
Cost component Total cost cost
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Project Development..................... $49,161 $16,377
Data Collection Activities.............. 123,478 41,159
Data Processing and Analysis............ 109,433 36,478
Publication of Results.................. 81,836 27,279
Project Management...................... 18,438 6,146
Overhead................................ 117,531 39,177
[[Page 24957]]
Government Oversight.................... 13,710 4,570
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Total............................... 499,877 166,626
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Request for Comments
In accordance with the Paperwork Reduction Act, 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 healthcare research and
healthcare 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: April 19, 2012.
Carolyn M. Clancy,
Director.
[FR Doc. 2012-10007 Filed 4-25-12; 8:45 am]
BILLING CODE 4160-90-M