[Federal Register Volume 79, Number 67 (Tuesday, April 8, 2014)]
[Notices]
[Pages 19333-19335]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-07795]


-----------------------------------------------------------------------

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.

-----------------------------------------------------------------------

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: ``Taking Efficiency Interventions in Health Services Delivery 
to Scale.'' 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.

DATES: Comments on this notice must be received by June 9, 2014.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by email at 
[email protected].
    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

Taking Efficiency Interventions in Health Services Delivery to Scale

    The primary care workforce is facing imminent clinician shortages 
and increased demand. With the implementation of the Affordable Care 
Act (ACA), Federally Qualified Health Centers (FQHCs) are expected to 
play a major role in addressing the large numbers of people who become 
eligible for health insurance as well as continue in their role as 
safety net providers. Thus, understanding new models of service 
delivery and improving efficiency within FQHCs is of national policy 
import. The proposed data collection supports this goal through 
studying outcomes associated with a ``delegate model,'' which is 
designed to improve provider and team efficiency, and the spread of 
this model throughout a large FQHC.
    Recent models of practice transformation have documented the

[[Page 19334]]

use of an Organized Team Model that distributes responsibility for 
patient care among an interdisciplinary team, thus allowing physicians 
to manage a larger panel size while practicing high quality care. This 
delegate model requires that all team members perform at the top of 
their skill level, and that tasks currently performed by clinicians are 
delegated to non-clinician team members in a safe and effective manner. 
Researchers at the University of California, San Francisco have 
estimated that delegation may allow physicians to increase their panel 
size by shifting tasks to non-physician team members. More 
specifically, if portions of preventive and chronic care services are 
delegated to non-physicians, primary care practices can meet 
recommended quality and care guidelines while maintaining panel sizes 
with a limited primary care physician workforce. This study will 
examine the real-world implementation of such a model in order to build 
evidence of whether such delegation can achieve the predicted increases 
in panel sizes.
    AHRQ is working with John Snow, Inc. (JSI) and its partner, 
Penobscot Community Health Center (PCHC), to evaluate the effectiveness 
and spread of a delegate model in 5 of PCHC's 15 primary care service 
sites. The model will be spread from an initial pilot physician-medical 
assistant team to other clinics, as well as to other teams within each 
clinic. PCHC is an FQHC located in Bangor, Maine that serves 
northeastern Maine. Currently, PCHC's primary care providers (PCPs, 
which include medical doctors, osteopaths, nurse practitioners, and 
physician assistants) each work with a Medical Assistant (MA). Under 
the delegate model, a pair of PCPs will be assigned an 
``administrative'' MA to enhance their team. This position will enable 
shifting of responsibilities among the team, with the intent of 
relieving the PCPs of administrative tasks and incorporating new tasks 
that will enhance team efficiency. Examples of tasks that an 
administrative MA may take on include standardized prescription 
renewals, schedule management, in-box management, scribing, pre-visit 
planning with pre-appointment laboratory tests, and identification of 
patients for ancillary referrals (e.g., behavioral health and case 
management).
    This study has the following goals:
    (1) To evaluate the spread and effectiveness of the delegate model 
in five of PCHC's primary care sites;
    (2) To evaluate the influence of the delegate model on provider 
satisfaction, team functioning, and patient satisfaction;
    (3) To assess the contextual factors influencing the above 
outcomes; and
    (4) To disseminate findings.
    This study is being conducted by AHRQ through its contractor, JSI, 
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

    AHRQ seeks approval for the following data collection activities:
     Team Survey that will be disseminated to all members of 
both delegate and non-delegate primary care teams to assess job 
satisfaction and team functioning in all participating sites at two 
points in time.
     Key Informant Interviews (KII) conducted with staff in 
each of the participating sites during two rounds of site visits, with 
key informants to include the Medical Director, Practice Director, 
members of primary care teams implementing the delegate model, and 
ancillary staff. A condensed version of the interview will be used for 
a conference call with each participating site's Medical Director and 
Practice Director as an interim activity between the two site visits.
    The information yielded from this study is expected to inform a 
wide cross section of audiences and stakeholders about provider 
efficiency, practice redesign, team-based care, workforce strategies, 
and spread of an innovation. This study is not intended to make broad 
generalizations about the effectiveness of the delegate model of care, 
but rather to build initial evidence about this promising new model, 
its ability to increase panel size in FQHCs, and provide guidance on 
how similar models might be spread and evaluated.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden for the 
respondents' time to participate in this research. Information will be 
collected through an internet-based team survey and in-person and 
telephone interviews. Note that some respondents may be double-counted, 
so the total number of respondents may be less than 80. For example, a 
respondent may fill out a survey as well as participate in a phone 
interview.
    Exhibit 2 shows the estimated annualized cost burden associated 
with the respondents' time to participate in this research. The total 
annual cost burden is estimated to be $25,151.

                                  Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
                                                                     Number of
                    Form name                        Number of    responses  per     Hours per     Total  burden
                                                    respondents      respondent      response          hours
----------------------------------------------------------------------------------------------------------------
Team Survey:
    --Providers.................................              21               2           15/60              11
    --Other Clinical Staff......................              34               2           15/60              17
                                                 ---------------------------------------------------------------
        Total...................................              55               2           15/60              28
Key Informant Interviews (Site visits):
    --Medical Director..........................               2               2           30/60               2
    --Practice Director.........................               2               2           30/60               2
    --Providers.................................               5               2           30/60               5
    --Other Clinical Staff......................              10               2           30/60              10
                                                 ---------------------------------------------------------------
        Total...................................              19               2           30/60              19
Key Informant Interviews (Phone calls):
    --Medical Director..........................               3               1               1               3

[[Page 19335]]

 
    --Practice Director.........................               3               1               1               3
                                                 ---------------------------------------------------------------
        Total...................................               6               1               1               6
                                                 ===============================================================
Total...........................................              80              na              na              53
----------------------------------------------------------------------------------------------------------------


                                   Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                    Form name                        Number of     Total  burden   hourly  wage     Total  cost
                                                    respondents        hours           rate*          burden
----------------------------------------------------------------------------------------------------------------
Team Survey:
    --Providers.................................              21              11      \a\ $62.13         $14,352
    --Other Clinical Staff......................              34              17       \b\ 14.69           8,491
                                                 ---------------------------------------------------------------
        Total...................................              55              28              na          22,843
Key Informant Interviews (Site Visit):
    --Medical Director..........................               2               2       \c\ 92.08             368
    --Practice Director.........................               2               2       \d\ 47.34             189
    --Providers.................................               5               2       \a\ 62.13             621
    --Other Clinical Staff......................              10               2       \b\ 14.69             294
        Total...................................              19               8              na           1,472
                                                 ---------------------------------------------------------------
Key Informant Interviews (Phone calls):
    --Medical Director..........................               3               2       \c\ 92.08             552
    --Practice Director.........................               3               2       \d\ 47.34             284
                                                 ---------------------------------------------------------------
        Total...................................               6               4              na             836
                                                 ===============================================================
Total...........................................              80              na              na          25,151
----------------------------------------------------------------------------------------------------------------
\*\ National Compensation Survey: Occupational wages in the United States May 2012, ``U.S. Department of Labor,
  Bureau of Labor Statistics.''
\a\ Based on the average mean wages for three categories of primary care provider ($92.08--MDs; $44.45 PAs; and
  $43.97--NPs).
\b\ Based on the mean wage of Medical Assistants.
\c\ Based on the mean wages for MDs.
\d\ Based on the mean wages for Medical and Health Services Managers.
\e\ Based on the mean wages for Data Analyst (Computer and Information Analyst).

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 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: March 31, 2014.
Richard Kronick,
AHRQ Director.
[FR Doc. 2014-07795 Filed 4-7-14; 8:45 am]
BILLING CODE 4160-90-P