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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality

NOTICE: NOTICES

DOCUMENT ACTION: Notice.

SUBJECT CATEGORY: Agency Information Collection Activities: Proposed Collection; Comment Request

DATES: Comments on this notice must be received by April 15, 2008.

DOCUMENT 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: ``Feasibility of secure messaging for pediatric patients with chronic disease: Pilot implementation in pediatric respiratory medicine.'' In accordance with the Paperwork Reduction Act of 1995, 44 U.S.C. 3506(c)(2)(A), AHRQ invites the public to comment on this proposed information collection.

SUMMARY: Reader Aids; ; Agency Information Collection Activities; Proposals, Submissions, and Approvals,

SUPPLEMENTAL INFORMATION

Proposed Project
Feasibility of Secure Messaging for Pediatric Patients With Chronic Disease: Pilot Implementation in Pediatric Respiratory Medicine

AHRQ proposes to evaluate how the implementation of a secure email messaging (emessaging) system between clinicians and adolescent patients affects: (1) Time spent by providers communicating with patients, (2) Emergency Department utilization for medication refills, and (3) qualitative satisfaction with care of the patients. The study will be conducted in the Yale University School of Medicine Pediatric Respiratory Medicine Clinic.

Several studies have evaluated the use of email between providers and patients and found that it is typically satisfactory to both, has not been abused by patients, and has not been used inappropriately for urgent items. Studies have not evaluated the use of emailing or secure messaging by children or adolescents with chronic diseases as well as their families. The setting of chronic disease provides a natural forum for discussion about the use of such technologies since these families may need more frequent contact with their careproviders, need more frequent medication refills, and may have close relationships with their providers that encourage a communication genre such as secure messaging.

In particular, because many adolescents are comfortable with text messaging and email, the investigators hypothesize that adolescent patients themselves may feel empowered to contact their providers using this medium. This potential shift to having adolescents communicate with the providers presents two main hypotheses of interest. (1) Adolescents may be more prone to send a message that may be of an urgent nature because of the sense that messaging is``instant'' as well as a possible feeling of more privacy. This issue presents the concern that adolescents in particular could send a secure message about information that is potentially urgent in nature such as a severe asthma exacerbation or suicidal ideation. Such messages will need immediate attention. (2) Adolescents may be more apt to disclose questions about their care that they would not have otherwise brought up with the provider. By giving adolescents a medium where they feel comfortable communicating, clinicians may be able to better meet the medical and psychosocial needs of adolescents and their families. [[Page 8873]]

Method of Collection

The project will include 300 patient/family participants and 138 provider participants. Data will be collected from (1) emessaging content, to understand what children, adolescents and their parents will send in secure messages to their provider; (2) a survey, to determine the demographic characteristics of the patients and their family; and (3) qualitative interviews with patients and their families and clinic staff, to assess their attitudes and satisfaction with e messaging.

Estimated Annual Respondent Burden

Exhibit 1 shows the estimated annualized burden hours. Each of the 300 patient/family participants will complete a demographic survey and use the emessaging system, sending an average of one emessage per month. Thirty of the patient/family participants will be randomly selected to participate in a qualitative interview. Each of the 138 provider participants will use the emessaging system, responding to about twentysix emessages per year, and keep a pre and post intervention log of patient/provider communications. Ten provider participants will be randomly selected to participate in a qualitative interview. The total burden for all participants is estimated to be 2,148 hours.

Exhibit 2 shows the estimated annualized cost burden for the participants' time to participate in this study. The total cost burden for all participants is estimated to be $72,664.
Exhibit 1.Estimated Annualized Burden Hours Number of Interview participants Number of responses per Hours per Total burden respondents respondent response hours Patient/Family Participants:

Demographic Survey.......................... 300 1 1 300

Emessaging................................. 300 12 15/60 900

Qualitative Interview....................... 30 1 30/60 15 Provider Participants:

Emessaging................................. 138 26 15/60 900

Qualitative Interviews...................... 10 1 30/60 5

Preintervention Provider Log............... 138 1 6/60 14

Postintervention Provider Log.............. 138 1 6/60 14
Total................................... 438 na na 2,148 Exhibit 2.Estimated Annualized Cost Burden Number of Total burden Average hourly Total cost Interview participants respondents hours wage rate* burden Patient/Family Participants:

Demographic Survey.......................... 300 300 $26.20 $7,860

Emessaging................................. 300 900 26.20 23,580

Qualitative Survey.......................... 30 15 26.20 393 Provider Participants:

Emessaging................................. 138 900 43.78 39,402

Qualitative Interviews...................... 10 5 43.78 219

Preintervention Provider Log............... 138 13.8 43.78 605

Postintervention Provider Log.............. 138 13.8 43.78 605
Total................................... 438 na na 72,664 * For Patient/Family Participants: Based upon the mean of the average wages for all occupations, National Compensation Survey, ``U.S. Department of Labor, Bureau of Labor Statistics.'' * For Provider Participants: Based upon the mean of the average wages for physicians ($65.54/hr) and nurses ($43.85/hr) in the New York, New Jersey, Connecticut and Pennsylvania region, National Compensation Survey, ``U.S. Department of Labor, Bureau of Labor Statistics.'' For Pulmonary Fellows: Based upon internal Yale University School of Medicine data.
[[Page 8874]]

Estimated Annual Costs to the Federal Government

The total cost to the Federal Government for this project is $399,970 over a two year period. The average annual cost is $199,985. The following is a breakdown of the average annual costs:

Direct Costs:

Personnel.......................................... $159,488.5

Consultancies...................................... 5,475

Data support....................................... 5,336.5 Indirect Costs:

Indirect costs..................................... 29,685
Total.......................................... 199,985 Request for Comments

In accordance with the abovecited Paperwork Reduction Act legislation, 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: February 6, 2008.
Carolyn M. Clancy,
Director.
[FR Doc.08659 Filed 21408; 8:45 am]
BILLING CODE 416090M

FOR FURTHER INFORMATION CONTACT Doris Lefkowitz, AHRQ Reports Clearance Officer, (301) 4271477, or by email at
doris.lefkowitz@ahrq.hhs.gov.

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