Federal Register: September 3, 2008 (Volume 73, Number 171)
DOCID: fr03se08-77 FR Doc E8-20315
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
NOTICE: NOTICES
DOCID: fr03se08-77
DOCUMENT ACTION: Notice.
SUBJECT CATEGORY:
Agency Information Collection Activities: Proposed Collection; Comment Request
DATES: Comments on this notice must be received by November 3, 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: ``Study of Factors Influencing Consumer Choices Among Health Plans and Clinicians.'' In accordance with the Paperwork Reduction Act of 1995, Public Law 10413 (44 U.S.C. 3506(c)(2)(A)), AHRQ invites the public to comment on this proposed information collection.
SUMMARY:
Agency Information Collection Activities; Proposals, Submissions, and Approvals,
SUPPLEMENTAL INFORMATION
Proposed Project
``Study of Factors Influencing Consumer Choices Among Health Plans and Clinicians''
This study will use an experimental design to determine factors that influence consumer understanding and use of performance information to select among health plans and clinicians. Performance reports on health plans and individual providers have become increasingly available in recent years, but there is little evidence regarding how consumers understand and use different types of performance information to make choices.
The study will include two parallel experiments, one designed to assess factors influencing choice of health plans and one designed to assess factors influencing choice of individual doctors. Both experiments will present a panel of online consumers with a simulated Webbased performance report. Study subjects will answer a series of pretest questions, and then be directed to a Web site with a simulated report (for either health plans or doctors) where they will view various types of performance information, go through the process of selecting either a health plan or a doctor, and then complete the experiment by answering a series of posttest questions about how they made their selection.
The categories of performance information to be included in the Web reports will be derived from patient experience survey results using Consumer Assessment of Healthcare Providers and Systems (CAHPS) composite measures, clinical process measures, personal anecdotes based on patient or enrollee experiences, and the frequency of different types of enrollee complaints or grievances (in the plan experiment only).
The results of this study will be used to develop recommendations for helping consumers to better understand and more effectively use complex information to select health plans and providers, with the aim of making performance information less burdensome and more accessible, useful, and transparent to the public. The simulated Webbased reports will be made available as examples for other report developers to use. This study is being conducted pursuant to AHRQ's statutory mandate to promote health care quality improvement by conducting and supporting research that develops and presents scientific evidence regarding all aspects of health care, 42 U.S.C. 299(b)(1), and to conduct research on health care and on systems for the delivery of such health care, 42 U.S.C. 299a.
Method of Collection
Participants in this study will be recruited through the Knowledge
Networks national online panel of consumers. For both the health plan
and clinician choice experiments, study subjects will be randomly assigned to one of several arms (described below)
[[Page 51485]]
that vary according to the type and complexity of performance
information and the size of the choice set (number of plans or doctors)
included in the Web report. Participants will complete the experiment through a secure online connection from their homes.
Clinician Choice Experimental Design
In each of the six arms, study participants will see a web page
labeled ``Performance Overview'' that presents performance information
for a set of primary care doctors in a way that allows them to compare
doctor ratings. Performance is summarized by assigning one to five
stars to show how each doctor compares with others in the same zip code
area. Participants can click on hyperlinks or a tab to see more
detailed results. The experimental arms differ in the type and amount
of performance information presented and the number of doctors listed, as described below:
(1) Baseline/Control Arm: participants see only ``Patient Survey
Results'' for each of 12 doctors in this arm. This includes a summary
measure on the Performance Overview page and more detailed measures
corresponding to CAHPS composites and an overall doctor rating on the drilldown page.
(2) Experimental Arm #1: Augmented Quantified Performance Measures:
In this arm participants will also see ``Patient Survey Results'' on 12
doctors. In addition, they will see a summary clinical performance
measure labeled ``Medical Quality Scores.'' The drilldown page shows
that this is based on clinical indicators for prevention and screening,
care for asthma, care for diabetes, and care for heart disease.
(3) Experimental Arm #2: CAHPS plus Anecdotes: In this arm,
participants will again be presented with ``Patient Survey Results'' on
12 doctors. In addition, for each doctor, they will see a tab labeled
``Patient Comments.'' By clicking on this tab, they can see from four
to six patient comments describing patients' experiences with each
doctor. Participants in this arm will not see clinical performance scores.
(4) Experimental Arm #3: Augmented Quantified Performance Measures
Plus Anecdotes: In this arm participants will be presented with all
three types of information on 12 doctors: ``Patient Survey Results,'' ``Medical Quality Scores'', and ``Patient Comments.''
(5) Experimental Arm #4: CAHPS plus Anecdotes and Larger Choice
Set: In this arm participants will be presented with ``Patient Survey Results'' and ``Patient Comments'' on 24 doctors.
(6) Experimental Arm #5: Maximum Cognitive Load: Large Choice Set
and Three Measures of Performance: In this arm, participants are
presented with all three types of information on 24 doctors: ``Patient
Survey Results,'' ``Medical Quality Scores,'' and ``Patient Comments.''
The goals of the experiment are to assess the process of consumer choice and the extent to which CAHPStype measures are consulted, and to examine how consumers respond to different types of information about doctor quality, including quantitative patient experience measures, anecdotal reports from individual patients, and clinical performance indicators. The posttest questionnaire will elicit participants' understanding and impressions of the material they saw on the Web site and inquire about how they made their choice. Therefore, the posttest questions will differ somewhat across experimental arms. Health Plan Choice Experimental Design
The design of the health plan choice experiment has a comparable
architecture to the clinicianchoice experiment, but makes choices more
challenging by adding more dimensions of performance measures within a
smaller choice set. (These distinctions between informed clinician
choice and informed plan choice replicate the information currently
available to consumers over the internet.) In each of the six arms,
study participants will see a web page labeled ``Performance Overview''
that presents performance information for a set of health plans in a
way that allows them to compare plan ratings. Performance is summarized
by assigning one to five stars to show how each plan compares with
others in the same community. Participants can click on hyperlinks or a
tab to see more detailed results. The experimental arms differ in the
type and amount of performance information presented and the number of plans listed, as described below:
(1) Baseline/Control Arm: participants see only ``Patient Survey
Results'' for each of 4 plans in this arm. This includes a summary
measure on the Performance Overview page and more detailed measures
corresponding to CAHPS composites and an overall plan ratings on the drilldown page.
(2) Experimental Arm #1: Augmented Quantified Performance Measures:
In this arm participants will also see ``Patient Survey Results'' on
four plans. In addition, they will see two summary clinical performance
measures labeled ``Health Care Quality Scores,'' which will consist of
selected Health Care Effectiveness Data and Information Set (HEDIS)
measures, one for preventive care, and one for the treatment of chronic
conditions. The drilldown page for prevention will show preventive
care scores of regular physical exams, and screening for three common
medical conditions. The drill down page for treatment will include
summary measures for heart problems, asthma, diabetes, and arthritis. A
summary score for the reported rate of consumer complaints will also be
included, with a drill down reporting rating for the four most common
causes of complaints, with the categories based on actual data from three states.
(3) Experimental Arm #2: CAHPS plus Anecdotes: In this arm,
participants will again be presented with ``Patient Survey Results'' on
four plans. In addition, for each plan, they will see a tab labeled
``Patient Comments.'' By clicking on this tab, they can see from four
to six patient comments describing patients' experiences with each
plan. Participants in this arm will not see quality performance or rates of patient complaints scores.
(4) Experimental Arm #3: Augmented Quantified Performance Measures
Plus Anecdotes: In this arm participants will be presented with all
four types of information for four plans: ``Patient Survey Results,''
``Health Care Quality Scores'', ``Patient Complaint Rates'' and ``Patient Comments.''
(5) Experimental Arm #4: CAHPS plus Anecdotes and Larger Choice
Set: In this arm participants will be presented with ``Patient Survey Results'' and ``Patient Comments'' on 12 plans.
(6) Experimental Arm #5: Maximum Cognitive Load: Large Choice Set
and Five Measures of Performance: In this arm, participants are
presented with all three types of information: ``Patient Survey
Results,'' ``Health Care Quality Scores'' (both prevention and
treatment), ``Patient Complaint Rates'' and ``Patient Comments'' on 12 plans.
The goal of these experiments is to assess the process of consumer
choice and the extent to which CAHPStype measures are consulted, and
to examine how consumers respond to different types of information
about plan performance, including quantitative patient experience
measures, anecdotal reports from individual patients, frequency of
consumer complaints, and clinical performance indicators. The posttest
questionnaire will elicit participants' understanding and impressions
of the material they saw on the Web site and inquire about how they
made their choice. Therefore, the posttest questions will differ somewhat across experimental arms.
[[Page 51486]]
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
respondents' time to participate in this experiment. This experiment
will not exceed one year. All participants will complete the pretest
which is estimated to require 5 minutes. As explained above, the
experimental Web site varies by experimental arm, however, each
participant is expected to require about 10 minutes to review the
information on the site. The baseline/control posttest will be
completed by 170 participants and will require about 7 minutes to
complete. Both the experimental arm
Exhibit 2 shows the respondents' cost burden for their time to
participate in this experiment. The total cost burden is estimated to be $16,142.
Exhibit 1Estimated Annualized Burden Hours
Number of
Experimental group Number of responses per Hours per Total burden
responses respondent response hours Clinician Choice Experiment:
Pretest..................................... 1,000 1 5/60 83
Experimental Web site....................... 1,000 1 10/60 167
Baseline/Control Posttest.................. 170 1 7/60 20
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Pretest..................................... 1,000 1 5/60 83
Experimental Web site....................... 1,000 1 10/60 167
Baseline/Control Posttest.................. 170 1 7/60 20
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Total................................... 6,000 na na 838
Exhibit 2Estimated Annualized Cost Burden
Number of Total burden Average hourly Total cost
Experimental group responses hours wage rate* burden Clinician Choice Experiment:
Pretest..................................... 1,000 83 $19.26 $1,599
Experimental Web site....................... 1,000 167 19.26 3,216
Baseline/Control Posttest.................. 170 20 19.26 385
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Pretest..................................... 1,000 83 19.26 1,599
Experimental Web site....................... 1,000 167 19.26 3,216
Baseline/Control Posttest.................. 170 20 19.26 385
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Total................................... 6,000 838 na 16,142
*Based upon the mean of the average wages, National Compensation Survey: Occupational wages in the United States
2006, ``U.S. Department of Labor, Bureau of Labor Statistics.'' Estimated Annual Costs to the Federal Government
The total cost to the Federal Government for developing and
conducting both the health plan and clinician choice components of this
study is $844,000, including the cost of designing the experiments,
developing the simulated Webbased reports, conducting usability
testing of the Webreports, pilot testing the experiment, collecting
the data, analyzing the data, preparing reports and papers for journal submission, and the cost for AHRQ staff
[[Page 51487]]
to oversee the project; see Exhibit 3. The annualized cost for this two year project is $422,000.
Exhibit 3Project Cost Components
Cost
Cost components estimate
Experimental design......................................... $168,900
Development of simulated Webbased reports.................. 157,900
Pilot testing............................................... 56,000
Usability testing of Webbased reports...................... 56,300
Data collection via Knowledge Networks...................... 126,000
Data analysis............................................... 56,300
Preparation of reports and journal papers................... 112,600
AHRQ project management................................. 110,000
Total................................................... 844,000 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: August 26, 2008.
Carolyn M. Clancy,
Director.
[FR Doc. E820315 Filed 9208; 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.