and

Over time, the program has expanded beyond its original focus on health plans to address a range of health care services and meet the various needs of health care consumers, purchasers, health plans, providers, and policymakers. Based on the literature review and an assessment of currently available survey instruments, AHRQ identified the need to develop a new health information technology module of the CAHPS[supreg] survey. The intent of the planned module is to examine in greater detail than previously patients' perspective on health information technology use by their health care professionals. The intent of the new module is to provide information to clinicians, group practices, health plans, and other interested parties regarding the impact of the use of health information technology on patients' experiences with care. The set of questions about health information technology will be tested as a part of CAHPS[reg] Clinician & Group Survey, Adult Primary Care Questionnaire.

This study, funded through cooperative agreements with RAND and Harvard, is being conducted pursuant to AHRQ's statutory authority to conduct research and evaluations on health care and systems for the delivery of such care, including activities with respect to (1) the quality, effectiveness, efficiency, appropriateness and value of health care services and (2) health care
[[Page 14561]]
technologies, facilities and equipment. See 42 U.S.C. 299a(a)(1) and (5).

This study is a onetime field test to be conducted in calendar year 2009. The field test to be conducted under this request will be done for the following purposes:

a. Analysis of revised item wordingAssess candidate wordings for survey items

b. Mode AnalysisEvaluate the equivalence of items administered by mail, telephone, and internet; compare the characteristics and responses of respondents who complete the survey by different modes of administration.

c. Case mix adjustment analysisEvaluate variables that need to be considered for case mix adjustment of scores.

d. Psychometric AnalysisProvide information for the revision and shortening of questionnaires based on the assessment of the reliability and validity of survey items and composites.

The end result will be a data collection related to the assessment of patients' perspective on how well health information technology is being used by health care professionals. The field testing will ensure that the future data collection yields high quality data and to ensure a minimization of respondent burden, increase agency efficiency, and improve responsiveness to the public. The survey items will be added to currently available CAHPS[reg] surveys and will provide a venue to clinicians and practitioners to verify the quality of their services. Method of Collection

Respondents will be selected from four purposively chosen sites (health care providers and health insurance plans) that have implemented health information technology systems, such as electronic health records (EHRs) and electronic prescription refills, that are used by sufficient numbers of enrollees (i.e., at least 2400 enrollees per site). From each site the potential respondent universe will be patients who have been receiving care from a clinician at the health provider for at least one year prior to the survey and who have used one or more features of the health providers' EHR system. EHR systems managers have the ability to track which patients log on to the system, and which features (e.g., examine lab results, request prescription refill, etc.) the patients used. The sample selection at each site will be carried out jointly by senior leadership at the site (e.g., chief information officer) and a survey vendor experienced in conducting the CAHPS survey. We will ask the sites to provide a list of their enrollees who have seen a provider in the last 12 months and who have logged onto the EHR system in the last 12 months. We will randomly select a sample of these enrollees for the field test. We will use common statistical techniques to select the sample, e.g., computerized random number generation applied to a list of enrollees. When possible, we will stratify the enrollees at a site based on extent of HIT exposure to ensure a mix of different enrollees in the study (e.g., enrollees who use many HIT functions versus those who use few HIT functions). Institutional Review Boards (IRBs) at Harvard and RAND evaluated the study to ensure proper protection of patients' right to privacy and confidentiality as well as avoidance of harm. The study received approvals from both IRBs.

The draw will be a sample large enough to yield approximately 4,800 respondents.

Because we are assuming a 50% response rate, we will draw approximately 9,600 patients to achieve our total of 4,800 respondents.

Sites to be selected will meet the following requirements:

We anticipate a mixed mailtelephone mode of data collection which will include the following steps:

We will also administer the survey by Internet to some of the study participants. For those assigned to Internet administration an email invitation will be sent that includes an invitation to participate along with a URL link to a Webbased survey hosted on a secure server. Sites will be divided between RAND's Survey Research Group and the Center for Survey Research, University of Massachusetts, Boston (CSR). RAND will use the software CfMC to administer the survey, while CSR will use Snap software.

Estimated Annual Respondent Burden

Exhibit 1 shows the estimated annualized burden for the respondents' time to participate in this data collection. The CAHPS[supreg] Clinician & Group Survey, Adult Primary Care Questionnaire will be completed by about 4,800 persons. The estimated response time of 20 minutes is based on the written length of the survey and AHRQ's experience with previous CAHPS[supreg] surveys of comparable length that were fielded with a similar, although not identical, population. The total burden hours are estimated to be 1,600 hours.

Exhibit 2 shows the respondents' cost burden associated with their time to participate in this data collection. The total cost burden is estimated to be $31,296.
Exhibit 1Estimated Annualized Burden Hours Number of Number of responses Hours per Total Form name respondents per response burden respondent hours CAHPS[supreg] Clinician & Group Survey, Adult Primary Care 4800 1 20/60 1600 Questionnaire..............................................

Total................................................... 4800 1 na 1600 [[Page 14562]]
Exhibit 2Estimated annualized cost burden Total Average Form name Number of burden hourly wage Total cost respondents hours rate * burden CAHPS[supreg] Clinician & Group Survey, Adult Primary Care 4800 1600 $19.56 $31,296 Questionnaire..............................................

Total................................................... 4800 1600 na 31,296 * Based upon the average wages, ``National Compensation Survey: Occupational Wages in the United States, May 2007,'' 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 the Health Information Technology questions, and testing them within the CAHPS[supreg] Clinician & Group Survey, Adult Primary Care Questionnaire, is $780,000, including the cost of reviewing the literature, conducting focus groups and cognitive interviews, field testing the instrument, analyzing the data, finalizing the survey, preparing reports, writing papers for journal submission, and project management (see Exhibit 3). Data collection will not exceed one year. Exhibit 3Estimated Annual Cost
Cost component Total cost Review of literature....................................... $35,000 Focus groups............................................... 60,000 Cognitive interviews....................................... 80,000 Field test................................................. 260,000 Data analyses.............................................. 80,000 Finalize survey............................................ 50,000 Preparation of reports and journal papers.................. 85,000 AHRQ project management.................................... 130,000

Total.................................................. $780,000 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 0MB approval of the proposed information collection. All comments will become a matter of public record.

Dated: March 20, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E96956 Filed 33009; 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.