Federal Register: May 13, 2009 (Volume 74, Number 91)
DOCID: fr13my09-64 FR Doc E9-11009
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
NOTICE: NOTICES
DOCID: fr13my09-64
DOCUMENT ACTION: Notice.
SUBJECT CATEGORY:
Agency Information Collection Activities: Proposed Collection; Comment Request
DATES: Comments on this notice must be received by June 12, 2009.
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: ``Coordinating Care across Primary Care and Specialty Care Practices.'' 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.
This proposed information collection was previously published in the Federal Register on March 5th, 2009 and allowed 60 days for public comment. One comment was received. The purpose of this notice is to allow an additional 30 days for public comment. This notice differs from the 60 day notice in that the Patient Satisfaction Survey has been eliminated.
SUMMARY:
Agency Information Collection Activities; Proposals, Submissions, and Approvals
SUPPLEMENTAL INFORMATION
Proposed Project
``Coordinating Care across Primary Care and Specialty Care Practices.''
AHRQ proposes an evaluation of the redesign of the transitions of care between primary care and specialty care services. The purpose of the redesign is to remedy inefficiencies in the current referral processes that threaten care quality and safety, and system efficiency. This redesign is being implemented at the Boston Medical Center (BMC), and two affiliated health centers. The evaluation will be conducted for AHRQ by its contractor, the Boston University School of Public Health (BUSPH).
Care coordination has been identified by the Institute of Medicine
(IOM) as a key strategy with potential to improve the effectiveness,
safety and efficiency of the health care system. At the same time, care
coordination, particularly in transitions among sites of care, is often
lacking. Research shows that problems in coordination of care and
common failures in patients' transitioning between and among systems
typically create serious quality concerns in many settings. Individuals
moving across systems of care and between care providers are vulnerable
to fragmented and disjointed care (Coleman et al., 2004). Uncoordinated
and fragmented transitions can lead to a wide range of costly problems
and threats to patient safety including greater use of hospital and
emergency services (Coleman et al., 2004), ordering and completion of
redundant tests (Coleman & Berenson, 2004), prescription and medication
errors and use of polypharmacy by multiple providers (Coleman &
Berenson, 2004). The end result is often confusion about conflicting care plans and lack of followup care. The aim of
[[Page 22555]]
this evaluation is to address this confusion and fragmentation by
expanding knowledge of how to improve the experience and outcomes for
patients in transitions of care between primary care and specialty
practices. The initial focus is on referrals between primary care and
two specialties: gastroenterology (GI) and obstetrics (OB). The
redesigned referral system will be tested by implementing it in three
participating primary care sites and two specialty clinics. We expect
that the lessons learned from this evaluation will provide a model and
tools that can later easily be tested and applied to other sites and
specialties in the BMC system and provide lessons learned to other
systems seeking to sustainably improve their referral systems.
This project 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: The quality, effectiveness, efficiency, appropriateness and value of health care services; clinical practice, including primary care and practiceoriented research; and health care costs, productivity, organization, and market forces. See 42 U.S.C. 299a(a)(1), (4) and (6).
The overall aims of the evaluation are to provide a rigorous
assessment of the success of the redesigned referral system in meeting its improvement goals and to gain an understanding of the
implementation of the redesigned system.
Method of Collection
This evaluation will include the following data collections:
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
respondents' time to participate in this two year evaluation. Focus
groups will be conducted with about 21 clinical staff at each of the 3
primary care sites and 2 specialty care sites (Exhibit 1 shows 2.5
sites per year). Each focus group session will last about 45 minutes. The total annualized burden is estimated to be 39 hours.
Exhibit 1Estimated Annualized Burden Hours
Number of
Form name Number of responses per Hours per Total burden
respondents respondent response hours
Focus groups.................................... 2.5 21 45/60 39
Total....................................... 2.5 na na 39
Exhibit 2 shows the estimated annualized cost burden associated
with the respondents' time to participate in this project. The total annualized cost burden is estimated to be $1,463.
Exhibit 2Estimated Annualized Cost Burden
Average
Form name Number of Total burden hourly wage Total cost
respondents hours rate* burden
Focus groups.................................... 2.5 39 $37.50 $1,463
Total....................................... 2.5 39 na 1,463 * The hourly wage is based upon the weighted mean of the average wages for physicians ($58.76, n=45), clinical administrative staff ($17.64, n=30) and other clinical staff ($25.48, n=30). National Compensation Survey: Occupational Wages in the United States, U.S. Department of Labor, Bureau of Labor Statistics. June 2007, Summary 0703, http://www.bls.gov/ncs/ocs/sp/ncblo9 1 0.pdf. Accessed December 10, 2008. Estimated Annual Costs to the Federal Government
Exhibit 3 shows the estimated total and annualized cost for this
twoyear evaluation. The total cost is $155,110 and includes $23,267
for project development, $32,573 for data collection activities,
$31,022 for data processing and analysis, $15,511 for the publication
of results, $12,408 for project management and $40,329 for overhead. [[Page 22556]]
Exhibit 3Estimated Total and Annualized Cost
Annualized
Cost component Total cost cost
Project Development..................... $23,267 $11,633
Data Collection Activities.............. 32,573 16,287
Data Processing and Analysis............ 31,022 15,511
Publication of Results.................. 15,511 7,756
Project Management...................... 12,408 6,204
Overhead................................ 40,329 20,164
Total............................... 155,110 77,555 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, quality improvement and 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: May 4, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E911009 Filed 51209; 8:45 am]
BILLING CODE 416090M
FOR FURTHER INFORMATION CONTACT
Doris Lefkowitz, AHRQ Reports Clearance Officer, (301) 4271477, or by email at
doris.lefkowitz@ahrg.hhs.gov.