[Federal Register Volume 78, Number 26 (Thursday, February 7, 2013)]
[Notices]
[Pages 9051-9054]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-02549]


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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: ``Improving Sickle Cell Transitions of Care through Health 
Information Technology Phase 1.'' In accordance with the Paperwork 
Reduction Act, 44 U.S.C. 3501-3521, AHRQ invites the public to comment 
on this proposed information collection.

DATES: Comments on this notice must be received by April 8, 2013.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by email at 
doris.lefkowitz,AHRQ.hhs.gov.
    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 
AHRQ.hhs.gov">doris.lefkowitz@AHRQ.hhs.gov.

SUPPLEMENTARY INFORMATION:

Proposed Project

Improving Sickle Cell Transitions of Care Through Health Information 
Technology Phase 1

    This project is the first phase in AHRQ's effort toward the 
development of a health information technology (HIT) enabled tool 
designed to aid adolescents and young adults with sickle cell disease 
(SCD) during transitions of care. SCD is a serious, genetic blood 
disorder that affects approximately 70,000-100,000 Americans, including 
one out of every 500 African American and one

[[Page 9052]]

out of every 36,000 Hispanic American births. Persons with SCD produce 
abnormal, ``sickle-shaped'' red blood cells that obstruct blood 
vessels, leading to life-long anemia, organ damage, increased potential 
for infections, chronic episodes of pain, and substantially shortened 
life spans. SCD has been noted to be understudied relative to its 
prevalence resulting in a lack of knowledge about the important 
variables and domains that determine health outcomes for patients. 
Furthermore, patients with SCD, typically young, minority, and often of 
lower income status, have had few opportunities to voice their needs 
and concerns about their health and health care.
    As recently as 30 years ago, children with SCD usually did not 
survive into adulthood. Now, as a result of advances in screening and 
treatment, more than 90 percent of individuals with SCD reach 
adulthood, and life expectancy is typically into the fifth decade. 
Persons with SCD experience multiple transitions of care as a result of 
the chronicity of SCD, frequency of both acute and chronic events 
requiring care, as well as the advancements in life expectancy. 
Transitions of care occur when either the setting of care changes 
(e.g., from home-based to hospital-based care) or the focus of care 
changes (e.g., from pediatric-focused to adult-focused care). When 
transitions of care occur, a need to share medical history and other 
types of health information arises. Transitions of care are more likely 
to be successful when this health information is accurate, tailored to 
the type of transition taking place, and communicated effectively.
    Times of care transitions are particularly fraught for patients 
with SCD and currently, few patients have access to effective 
transition programs for SCD. In a 2010 survey of pediatric SCD 
providers, the majority claimed to have transition programs in place 
but they were often newly formed and without the ability to transfer 
care to adult providers with specific expertise in SCD.
    Preliminary evidence suggests that HIT can be helpful for SCD and 
similar conditions. In particular, a technology-based tool has already 
been used successfully by patients with SCD to help with some aspects 
of disease management. In one study, a handheld wireless device was 
used to implement a pain management protocol and found to result in 
high rates of participation and satisfaction. Technology-based tools or 
applications--``apps''--have also been effective in improving care 
transitions for other chronic diseases such as diabetes and HIV, which 
can serve as models for this tool.
    Improving transitions of care is the focus of AHRQ's plans to 
respond to the Department of Health and Human Services' (HHS') SCD 
Initiative announced in 2011. The overall HHS SCD initiative, which is 
aligned with AHRQ's mission, aims to improve the health of persons with 
SCD through various activities, including developing and disseminating 
evidence-based guidelines, increasing the availability of medical homes 
that provide SCD care, and supporting research in areas such as pain 
and disease management, all of which could also be supported through 
the use of an effective HIT enabled tool.
    The goals of this project are to:
    (1) Gain the necessary background knowledge including qualitative 
information from key stakeholders, to establish a set of requirements 
that would guide the design and development of a HIT-enabled tool in 
future phases of work that meets patients,' families,' and providers' 
needs to aid adolescents and young adults with sickle cell disease 
during transitions of care.
    (2) Develop an understanding of the environmental context, current 
facilitators and barriers, health data use and needs of key 
stakeholders affected by sickle cell disease, including patients, 
families, and providers.
    This study is being conducted by AHRQ through its contractor, The 
Lewin Group, pursuant to AHRQ's 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 health 
care technologies. 42 U.S.C. 299a(a)(1), (2) and (5).

Method of Collection

    To achieve the goals of this project, the following activities and 
data collections will be implemented:
    (1) Environmental Scan -- AHRQ will execute a literature review to 
identify potentially relevant scientific literature and information 
from other literature and sources as well as complete a search for 
existing tools that aid transitions of care for persons with SCD or 
similar conditions. This will provide contextual background about the 
current state of the field with regards to tool development and use, 
identify key issues of patients with SCD related to care transitions, 
and understand the context of care delivered and health data 
information needs to inform the content, design and functionality of a 
tool. This activity does not impose a burden on the public and is not 
included in the burden estimates in Exhibit 1.
    (2) Focus Groups -- AHRQ will facilitate ten focus groups of key 
stakeholder groups including: parents/caregivers of patients with SCD; 
health care providers (e.g. SCD specialists, primary care physicians 
(PCPs), hospitalists and emergency room (ER) physicians); IT 
developers; SCD patients ages 9-13; SCD patients ages 14-17; SCD 
patients 18 and older; and SCD patients of mixed ages; to gather 
qualitative information on stakeholder experiences with SCD and care 
transitions, barriers to quality care, and use of technology to inform 
tool design and functionality. Each group will consist of 10 
participants and will be asked to describe their particular experiences 
with health care transitions, communication practices, information 
needs and technology use in order to develop relevant ``use cases'' 
which will be used by investigators and tool developers for the later 
phases of the project. The in-person nature of focus groups allows for 
a more in-depth and targeted discussion, including participant 
experiences, impressions and priorities in a detailed fashion.
    (3) Demographic Questionnaire -- AHRQ will implement a short 
demographic questionnaire at the start of each of the ten focus groups 
to collect basic demographic information to allow the team to 
contextualize findings from each focus group. Questionnaires are 
tailored to each focus group category: parents/caregivers of patients 
with SCD; providers, hospitalists and ER physicians); IT developers; 
SCD patients ages 9-13; SCD patients ages 14-17; SCD patients 18 and 
older; and SCD patients of mixed ages.
    (4) Key Informant Interviews -- AHRQ will conduct eight key 
informant interviews with stakeholders such as State Medicaid 
representatives, attorneys with expertise in privacy and security 
issues, representatives from the Office of the National Coordinator for 
Health Information Technology (ONC), Office of Chief Scientist, and 
other relevant policy makers. Qualitative information gained will 
contribute to tool development recommendations particularly in terms of 
cost, issues related to reimbursement by payers, needs for proof of 
effectiveness, sustainability, and potential vehicles for facilitating 
and funding tool development and implementation. Five of these 
stakeholders will be Federal government employees and therefore are 
excluded from the burden estimates in Exhibit 1 below.

[[Page 9053]]

    The information gained from the focus groups and key informant 
interviews will be used to understand if and how a patient-centered, 
HIT-enabled tool can improve the health of individuals with SCD during 
care transitions.
    Focus groups as a form of qualitative research are an important 
vehicle for gathering and explicating insight from the field, 
especially if, as in this case, the important domains are not yet 
understood, and need to be outlined by respondents, rather than 
suggested by investigators. Thus active recruitment and qualitative 
techniques are a means to incorporate this necessary and important 
perspective into the derivation of effective interventions. The primary 
objective of the focus groups is to gather more richly nuanced 
information from sickle cell disease stakeholders. The in-person nature 
of focus groups allows for a more in-depth and targeted discussion, 
including participant experiences, impressions and priorities in a 
detailed fashion.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
respondents' time to participate in this research. The demographic 
questionnaire will be completed by each focus group participant and 
takes 6 minutes to complete. All of the focus groups and key informant 
interviews will last 2 hours except for the IT developer focus group 
which will last 4 hours. Each focus group will consist of 10 persons. 
There will be two focus groups with providers, three with parents/
caregivers, one group for IT developers, and one focus group with each 
of the four patient groups. Key informant interviews will be conducted 
with eight individuals. The total burden is estimated to be 236 hours 
annually.
    Exhibit 2 shows the estimated annualized cost burden associated 
with the respondents' time to participate in this research. The total 
cost burden is estimated to be $7,646 annually.

                                  Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
                                                                     Number of
                    Form name                        Number of     responses per     Hours per     Total burden
                                                    respondents     respondent       response          hours
----------------------------------------------------------------------------------------------------------------
Demographic Questionnaire.......................             100               1            6/60              10
Provider Focus Groups...........................              20               1               2              40
Parent/Caregiver Focus Groups...................              30               1               2              60
IT Developer Focus Group........................              10               1               4              40
Patients 9-13 Focus Group.......................              10               1               2              20
Patients 14-17 Focus Group......................              10               1               2              20
Patients 18 & older Focus Group.................              10               1               2              20
Patients mixed ages Focus Group.................              10               1               2              20
Key Informant Interviews........................               3               1               2               6
                                                 ---------------------------------------------------------------
    Total.......................................             203              na              na            236
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* Five interview participants will be Federal government employees and therefore are excluded from the burden
  estimates.


                                   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
----------------------------------------------------------------------------------------------------------------
Demographic Questionnaire.......................             100              10      \a\ $26.89            $269
Provider Focus Groups...........................              20              40        \b\ 88.7           3,551
Parent/Caregiver Focus Groups...................              30              60       \a\ 21.74           1,304
IT Developer Focus Group........................              10              40       \d\ 44.27           1,771
Patients 9-13 Focus Group.......................              10              20           \e\ 0               0
Patients 14-17 Focus Group......................              10              20           \e\ 0               0
Patients 18 & older Focus Group.................              10              20       \a\ 21.74             435
Patients mixed ages Focus Group.................              10              20           \e\ 0               0
Key Informant Interviews........................               3               6       \f\ 52.72             316
                                                 ---------------------------------------------------------------
    Total.......................................             203             236              na          7,646
----------------------------------------------------------------------------------------------------------------
\a\ Based on the mean wages for Physicians & Surgeons, All other (29-1069), All Occupations (00-0000), Software
  Developer (15-1132). Wages for children averaged in as $0.
\b\ Based on the mean wages for Physicians & Surgeons, All other (29-1069).
\c\ Based on the mean wages for All Occupations (00-0000).
\d\ Based on the mean wages for Software Developer (15-1132).
\e\ No wage data for children.
\f\ Based on the mean wages for Lawyers (23-1011), Social and Community Service Managers (11-9151), Medical and
  Health Services Managers (11-9111), and Computer and Information System Managers (11-3021).
* National Compensation Survey: Occupational wages in the United States May 2011, ``U.S. Department of Labor,
  Bureau of Labor Statistics.'' http://www.bls.gov/oes/current/oes_nat.htm#15-0000.

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 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

[[Page 9054]]

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: January 23, 2013.
Carolyn M. Clancy,
Director.
[FR Doc. 2013-02549 Filed 2-6-13; 8:45 am]
BILLING CODE 4160-90-M