[Federal Register Volume 84, Number 129 (Friday, July 5, 2019)]
[Notices]
[Pages 32177-32178]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-14300]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[60Day-19-19BCG; Docket No. CDC-2019-0053]
Proposed Data Collection Submitted for Public Comment and
Recommendations
AGENCY: Centers for Disease Control and Prevention (CDC), Department of
Health and Human Services (HHS).
ACTION: Notice with comment period.
-----------------------------------------------------------------------
SUMMARY: The Centers for Disease Control and Prevention (CDC), as part
of its continuing effort to reduce public burden and maximize the
utility of government information, invites the general public and other
Federal agencies the opportunity to comment on a proposed and/or
continuing information collection, as required by the Paperwork
Reduction Act of 1995. This notice invites comment on a proposed
information collection project titled Core Elements of Antimicrobial
Stewardship in Nursing Homes. The goal of the information collection is
to assess the impact of an intervention on the knowledge, attitudes,
practices, and perceived provider-level barriers to appropriate
antibiotic prescribing in a sample of health care providers in nursing
homes. The data will be used to monitor the effect of an intervention
aimed at improving the antibiotic stewardship behaviors of prescribers
in long-term care settings.
DATES: CDC must receive written comments on or before September 3,
2019.
ADDRESSES: You may submit comments, identified by Docket No. CDC-2019-
0053 by any of the following methods:
Federal eRulemaking Portal: Regulations.gov. Follow the
instructions for submitting comments.
Mail: Jeffrey M. Zirger, Information Collection Review
Office, Centers for Disease Control and Prevention, 1600 Clifton Road
NE, MS-D74, Atlanta, Georgia 30329.
Instructions: All submissions received must include the agency name
and Docket Number. CDC will post, without change, all relevant comments
to Regulations.gov.
Please note: Submit all comments through the Federal eRulemaking
portal (regulations.gov) or by U.S. mail to the address listed above.
FOR FURTHER INFORMATION CONTACT: To request more information on the
proposed project or to obtain a copy of the information collection plan
and instruments, contact Jeffrey M. Zirger, Information Collection
Review Office, Centers for Disease Control and Prevention, 1600 Clifton
Road NE, MS-D74, Atlanta, Georgia 30329; phone: 404-639-7570; Email:
[email protected].
SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995
(PRA) (44 U.S.C. 3501-3520), Federal agencies must obtain approval from
the Office of Management and Budget (OMB) for each collection of
information they conduct or sponsor. In addition, the PRA also requires
Federal agencies to provide a 60-day notice in the Federal Register
concerning each proposed collection of information, including each new
proposed collection, each proposed extension of existing collection of
information, and each reinstatement of previously approved information
collection before submitting the collection to the OMB for approval. To
comply with this requirement, we are publishing this notice of a
proposed data collection as described below.
The OMB is particularly interested in comments that will help:
1. Evaluate whether the proposed collection of information is
necessary for the proper performance of the functions of the agency,
including whether the information will have practical utility;
2. Evaluate the accuracy of the agency's estimate of the burden of
the proposed collection of information, including the validity of the
methodology and assumptions used;
3. Enhance the quality, utility, and clarity of the information to
be collected; and
4. Minimize the burden of the collection of information on those
who are to respond, including through the use of appropriate automated,
electronic, mechanical, or other technological collection techniques or
other forms of information technology, e.g., permitting electronic
submissions of responses.
5. Assess information collection costs.
Proposed Project
Core Elements of Antimicrobial Stewardship in Nursing Homes--New--
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID),
Centers for Disease Control and Prevention (CDC).
Background and Brief Description
The purpose of this survey is to follow-up on formative research
(OMB Control Number 0920-1154), which assessed the knowledge,
attitudes, practices and perceived provider-level barriers to
appropriate antibiotic prescribing in a sample of health care providers
in nursing homes. This survey was developed building upon foundational
work previously completed. The questions were originally pre-tested
among a select group (n=9) of prescribers recruited from the
participating corporations to both obtain responses, as well as
performing cognitive assessment to ensure clarity and robustness of
content.
The preliminary findings suggested that the questions presented
were clear and correctly understood and that the topics covered were
meaningful. The inclusion of length of time in practice was
specifically relevant as preliminary findings from the interviews,
albeit limited, suggest that a prescriber's approach and attitudes
surrounding antibiotic prescribing may be impacted by professional
tenure. Specifically, respondents described that the longer a
prescriber had been in practice, the more reluctant they were to modify
their prescribing behaviors.
General findings consistently centered on the variability in nurse/
provider communication. Themes of poor communication encompassed
multiple elements. Key themes included: Poor structure of information
sharing, the role of gatekeepers to the prescriber, insufficient or
otherwise irrelevant detail, and an absence of therapy recommendation
from the nurses. Additionally, respondents described the physical
environment/geographic context that contributed to possible instances
of over-prescribing: Limited availability of timely or rapid test
laboratory results, sites with affiliated labs that are closed on the
weekends (thus requiring a staff member to drive a sample multiple
hours to the nearest hospital), limited antibiotic options in the
facility's Emergency Kit (from which staff frequently draw when
starting a prescription).
The current phase incorporates the findings from previous
exploratory work and aims to address the quality of communication
between the nurses and prescribers while also respecting the rational
for initial antibiotic initiation. As the decision to initiate an
antibiotic prescription is largely influenced by factors beyond the
scope of this project, the current study targeted the role of the
antibiotic follow-up to engage the prescriber post-prescription to
reassess
[[Page 32178]]
the appropriateness of the initial prescription. Additional topics were
identified as important to the respondents as they expressed support to
include questions that cover individual perceptions of responsibility/
autonomy, the importance of the role of family and other social
pressures when deciding to make antibiotic decisions, and the process
of following up with the resident post-prescription. The group of
respondents were comprised of a semi-convenience sample, with efforts
to target key administrative and practicing roles within the healthcare
setting to obtain a diverse and inclusive perspective.
Information will be used to provide descriptive analysis reports of
the prescribing climate within long-term care settings. We will use
these data as comparison to the initial survey deployment to
characterize any change demonstrated within the current antimicrobial
stewardship environment with an effort to identify key elements based
on staff interactions, perceived challenges, and any identifiable gaps
in knowledge. The specific elements within the survey will be used to
identify common needs shared across prescribers as areas for further
training or intervention development (e.g., identified barriers to
education or training resources will result in a more robust education
component to be included in future work). While this second survey is
not intended to establish a direct causal relationship, it does aim to
capture differences in a pre/post analysis style review without which,
the initial survey would simply provide a snapshot of current levels of
knowledge, attitudes, practices and perceived provider-level barriers
to appropriate antibiotic prescribing.
Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
Number of Average burden
Type of respondents Form name Number of responses per per response Total burden
respondents respondent (in hours) (in hours)
----------------------------------------------------------------------------------------------------------------
Doctors....................... Core Elements of 75 1 30/60 38
Antimicrobial
Stewardship in
Nursing Homes.
Nurse Practitioners........... Core Elements of 25 1 30/60 12
Antimicrobial
Stewardship in
Nursing Homes.
---------------------------------------------------------------
Total..................... ................ .............. .............. .............. 50
----------------------------------------------------------------------------------------------------------------
Jeffrey M. Zirger,
Lead, Information Collection Review Office, Office of Scientific
Integrity, Office of Science, Centers for Disease Control and
Prevention.
[FR Doc. 2019-14300 Filed 7-3-19; 8:45 am]
BILLING CODE 4163-18-P