[Federal Register Volume 81, Number 149 (Wednesday, August 3, 2016)]
[Notices]
[Pages 51199-51201]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-18392]


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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: ``The Patient-Centered Medical Home (PCMH) Items Demonstration 
Study.'' 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 October 3, 2016.

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: 

[[Page 51200]]

Proposed Project

The Patient-Centered Medical Home (PCMH) Items Demonstration Study

    This study is being conducted by AHRQ through its contractor, RAND, 
pursuant to AHRQ's statutory authority to conduct and support research 
on health care and on systems for the delivery of such care, including 
activities with respect to the quality, effectiveness, efficiency, 
appropriateness and value of health care services and with respect to 
quality measurement and improvement. 42 U.S.C. 299a(a)(1) and (2).

Method of Collection

    The patient-centered medical home (PCMH) is a model for delivering 
primary care that is patient-centered, comprehensive, coordinated, 
accessible, and continuously improved through a systems-based approach 
to quality and safety.
    As primary care practices across the United States seek National 
Committee for Quality Assurance (NCQA) recognition as patient-centered 
medical homes (PCMH), they can choose to administer the Consumer 
Assessment of Healthcare Providers and Systems (CAHPS[supreg]) 
Clinician and Group (CG-CAHPS) survey with or without the PCMH 
supplemental item set (AHRQ, 2010; Hays et al., 2014; Ng et al., 2016; 
Scholle et al., 2012). NCQA offers a special patient experience 
distinction to practices that opt to use the PCMH CAHPS items set in 
their CG-CAHPS survey tool. While over 11,000 practices, representing 
an estimated 15-18% of primary care physicians, are currently 
recognized for PCMH by NCQA (NCQA, 2015), fewer than 3% of them submit 
patient experience surveys to NCQA when applying for recognition under 
NCQA's PCMH recognition program.
    Despite the rapid movement toward PCMH primary care transformation 
and the increasing use of PCMH CAHPS items, little is known about the 
ways in which practices are using these CAHPS data and the PCMH 
supplemental item information (about access, comprehensiveness, self-
management, shared decision making, coordination of care, and 
information about care and appointments) to understand and improve 
their patients' experiences during PCMH transformation. The PCMH Items 
Demonstration Study will investigate:
     How practices across the U.S. use CAHPS and the PCMH item 
set during PCMH transformation,
     How practices assemble and select items for inclusion in 
their patient experience surveys (e.g. core, PCMH, supplemental, and 
custom items),
     Primary care practice leaders' perspectives on NCQA PCMH 
Recognition and CAHPS Patient Experience Distinction,
     Effects of changes made during PCMH transformation on 
patient experiences reported on CAHPS surveys and any PCMH items, and
     Associations between PCMH transformation and patient 
experience scores.
    To achieve the goals of this project the following data collections 
will be implemented:
    (1) Office Manager Questions administered via phone about the 
participating practice's characteristics to describe the type of 
practices in the study and to understand how practice characteristics 
influence PCMH transformation and patient experience.
    (2) Physician Interviews administered via phone with the lead PCMH 
clinical expert about the details, decisions and processes of PCMH 
transformation, NCQA PCMH Recognition and CAHPS Patient Experience 
Distinction and their use of patient experience data during the 
transformation process.
    (3) PCMH-A Assessment Tool to be completed by the lead PCMH 
clinical expert (before or after the interview on the standardized form 
via fax or email) to collect validated metrics on the ``PCMH-ness'' of 
the practice.
    (4) CAHPS Patient Experience Data Files, which are patient-level, 
de-identified CAHPS patient experience data covering the period of PCMH 
transformation for the participating practice. These data are collected 
independently of this study by the practice (or network) via its 
current vendor. We will work with the PCMH clinical expert, or a 
designated person who handles data, in each of the participating 
practices to submit these CAHPS data files securely to RAND to 
understand CAHPS patient experience trends and associations with PCMH 
implementation during the practice's PCMH journey.
    Characterizing the use of CAHPS and PCMH items by primary care 
practices will provide important insight into the activities practices 
conduct during PCMH transformation to improve patient experience 
scores. This information may be useful in supporting practices that lag 
behind their peers, learning from practices with outstanding records of 
patient experience, and providing recommendations that may be used to 
refine the content of the CAHPS survey items.

Estimated Annual Respondent Burden

    Table 1 shows the estimated annualized burden and cost for the 
respondents' time to participate in this data collection. These burden 
estimates are based on tests of data collection conducted on nine or 
fewer entities. As indicated below, the annual total burden hours are 
estimated to be 179 hours. The annual total cost associated with the 
annual total burden hours is estimated to be $16,899.
    The PCMH Items Demonstration Study will recruit 150 practices 
including the participating practices' office managers and one 
physician/lead PCMH clinical expert. We will recruit and administer the 
Office Manager Questions by phone to 150 office managers, recruit all 
sampled physicians by sending them a recruitment packet that includes a 
cover letter, an AHRQ endorsement letter and an information sheet, and 
then administer the Physician Interview protocol questions by phone to 
150 physicians, and 150 physicians will self-administer the PCMH-A 
Assessment Tool.
    We have calculated our burden estimate for Office Manager Questions 
asked during physician recruitment using an estimate of 3-5 questions a 
minute as the Office Manager Questions are closed-ended survey 
questions. The Office Manager Questions contains 17 questions and is 
estimated to require an average of 5 minutes; this estimate is 
supported by the information gathered during a pilot of these 
questions. For the Physician Interview, we have calculated the burden 
estimate to require an average of 40 minutes per interview. For the 
PCMH-A Assessment Tool, we calculated our burden using a conservative 
estimate of 4.5 items per minute. Prior work suggests that 3-5 items on 
an assessment tool can typically be completed per minute, depending on 
item complexity and respondent characteristics (Berry, 2009; Hays & 
Reeve, 2010). The PCMH-A Assessment tool contains 36 items and is 
estimated to require an average completion time of 8-10 minutes.
    Participating practices will be asked to submit any available CAHPS 
Patient Experience data files (e.g. submission of de-identified data 
including a data dictionary via encrypted transfer) for the period of 
time covering their NCQA PCMH Recognition history. Each practice will 
have an average estimate of 3 CAHPS Patient Experience data files to 
submit per one submission, which we based on the average number of 
years of PCMH history of the sample. In addition, we conservatively 
estimate

[[Page 51201]]

that half of the control practices (25/50) administer CG-CAHPS data, as 
this percentage is unknown; while 90% of the participating current and 
past CAHPS practices (90/100) will submit CAHPS data, yielding 115 
submissions of CAHPS patient experience data files. As indicated below, 
the annual total burden is estimated to be 179 hours.

                                  Exhibit 1--Estimated Annualized Burden Hours
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                                                            Number of responses      Hours per     Total burden
       Data collection task         Number of respondents      per respondent        response          hours
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Office Manager Questions..........  150..................  1....................            5/60            12.5
Physician Interview...............  150..................  1....................           40/60             100
PCMH-A Assessment Tool............  150 (same physicians   1 (same person as               15/60            37.5
                                     as above).             above).
CAHPS Patient Experience Data       115..................  1 per practice.......           15/60           28.75
 Files.
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    Total.........................  415..................  1....................           75/60          178.75
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+ The same respondent completes the Physician Interview and PCMH-A Assessment Tool and submits the CAHPS Patient
  Experience Data Files.


                                   Exhibit 2--Estimated Annualized Cost Burden
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                                                     Number of     Total burden   Average hourly    Total cost
              Data collection task                   requests          hours        wage rate *       burden
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Office Manager Questions........................             150            12.5      \a\ $57.44         $718.00
Physician Interview.............................             150             100       \b\ 97.33        9,733.00
PCMH-A Assessment Tool..........................             150            37.5       \b\ 97.33        3,649.88
CAHPS Patient Experience Data Files.............             115           28.75       \b\ 97.33        2,798.24
    Total.......................................             300          178.75           55.48       16,899.12
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+ The same respondent completes the Physician Interview and PCMH-A Assessment Tool and submits the CAHPS Patient
  Experience Data Files.
* Occupational Employment Statistics, May 2015 National Occupational Employment and Wage Estimates United
  States, U.S. Department of Labor, Bureau of Labor Statistics. http://www.bls.gov/oes/current/oes_nat.htm.
\a\ Based on the mean wages for General and Operations Managers, 11-1021 within Healthcare Support Occupations,
  the occupational group most likely tasked with completing the Office Manager Questions.
\b\ Based on the mean wages for Physicians and Surgeons, 29-1060, the occupational group most likely tasked with
  completing the Physician Interview, PCMH-A Assessment Tool, and submitting the CAHPS Patient Experience Data
  Files.

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.

Sharon B. Arnold,
Deputy Director.
[FR Doc. 2016-18392 Filed 8-2-16; 8:45 am]
 BILLING CODE 4160-90-P