[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
                                                 ---------------------------------------------------------------
    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
                                                 ---------------------------------------------------------------
    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
                                         -------------------------------
    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