Federal Register: July 22, 2009 (Volume 74, Number 139)
DOCID: fr22jy09-86 FR Doc E9-17203
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
NOTICE: NOTICES
DOCID: fr22jy09-86
DOCUMENT ACTION: Notice.
SUBJECT CATEGORY:
Agency Information Collection Activities: Proposed Collection; Comment Request
DATES: Comments on this notice must be received by August 21, 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: ``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. This proposed information collection was previously published in the Federal Register on September 3rd, 2008 and allowed 60 days for public comment. No comments were 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 the following ways: (1) The number of responses has been decreased from 6,000 to 4,950, (2) the burden hours are decreased from 838 to 709, and (3) the descriptions of each experimental arm in the sections: Clinician Choice Experimental Design and Health Plan Choice Experimental Design were removed.
SUMMARY:
Agency Information Collection Activities; Proposals, Submissions, and Approvals
SUPPLEMENTAL INFORMATION
Proposed Project
``Study of Factors Influencing Consumer Choices Among Health Plans and Clinicians''
AHRQ proposes to use an experimental design to determine factors
that influence consumers' understanding and use of performance
information to select among health plans and clinicians. The
experimental design 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. For both
the health plan and clinician choice experiments respondents will be
randomly assigned to one of six experimental arms that vary according to the type and complexity of performance information
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and the size of the choice set (number of plans or doctors) included in
the Webbased report. Respondents will complete the experiment through
a secure online connection from their homes. Data will be derived from
pre and posttest questionnaires and from server logs that record the web pages visited and viewing times.
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. This study, funded through cooperative agreements with the RAND Corporation and Harvard University, 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)(l), 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. The experimental designs of the clinician choice experiment and of the health plan choice experiment are discussed separately below.
Clinician Choice Experimental Design
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 geographic area. Participants can click on hyperlinks or a tab to see more detailed results. The six experimental arms differ in the type and amount of performance information presented and the number of doctors listed.
The goals of the experiment are to assess the process of consumer choice and the extent to which the Consumer Assessment of Healthcare Providers and Systems (CAHPS)type 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 across experimental arms.
Health Plan Choice Experimental Design
The basic design of the health plan choice experiment is similar to that used for the clinician choice experiment. The key difference in the choice set is that as is true in realworld choices health plan choice is made complex in the experiment by introducing a larger number of measures of performance, compared to those available to inform clinician choice. Even the simplest experimental arm has twice as many component measures for health plans as for clinicians. Reports from consumers include both anecdotes and a count of aggregate complaints that have been filed against the plan.
Potentially offsetting the cognitive burdens caused by additional measures, health plan choices typically involve fewer options than do clinician choices; in this choice experiment participants will face choice sets involving either 4 or 8 health plans.
A second substantial difference exists between the health plan and clinician choice experiments: the former assesses in an explicit manner the ways in which emotionality affects how consumers make use of information. It will do so in two ways. First, the counts of complaints mentioned above as an additional measure of plan performance represent a quantitative score with a stronger emotional valence than the other measures. Second, two of the experimental arms will ``prime'' respondents to think about health outcomes in a more emotionally laden manner, to see if this alters the way in which they process this information.
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 health plan quality, including customer services and accessibility of care issues, selected Healthcare Effectiveness Data and Information Set (HEDIS) measures for preventive care and treatment of chronic conditions, and selected reports on enrollee complaint rates and other issues. 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 across experimental arms.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the respondents' time to participate in this one year experiment. All participants will complete the pretest, which is estimated to require 5 minutes. As explained above, the experimental website varies by experimental arm; however, based on preliminary testing, each participant will require an average of 10 minutes to review the information on the site. The posttest questionnaires will require between 7 to 14 minutes to complete, depending on the experimental arm. The total burden hours are estimated to be 709 hours.
Exhibit 2 shows the respondents' cost burden associated with their
time to participate in this experiment. The total cost burden is estimated to be $13,887.
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 750 1 5/60 63
Experimental Web site....................... 750 1 10/60 125
Baseline/Control Arm Posttest.............. 125 1 7/60 15
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Web site....................... 900 1 10/60 150 [[Page 36234]]
Baseline/Control Arm Posttest.............. 150 1 7/60 18
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Total................................... 4,950 na na 709
Exhibit 2Estimated Annualized Cost Burden
Number of Total burden Average hourly Total cost
Experimental group respondents hours wage rate* burden
Clinician Choice Experiment: Pretest 750 63 $19.56 $1,232
Experimental Web site....................... 750 125 19.56 2,445
Baseline/Control Arm Posttest.............. 125 15 19.56 293
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Web site....................... 900 150 19.56 2,934
Baseline/Control Arm Posttest.............. 150 18 19.56 352
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Experimental Arm
Total................................... 4,950 709 na 13,887
*Based upon the mean of 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
Exhibit 3 shows the total and annualized cost for developing and
conducting both the health plan and clinician choice components of this
study, including the cost of designing the experiments, developing the
simulated Webbased reports, conducting usability testing of the Web
reports, pilot testing the experiment, collecting the data, analyzing
the data, preparing reports and papers for journal submission, and the
cost for AHRQ staff to oversee the project. The total and annual costs
are identical since data collection will not exceed one year. The total cost is estimated to be $844,000.
Exhibit 3Total and Annualized Costs
Cost components Total cost Annual cost
Experimental design..................... $168,900 $168,900
Development of simulated Webbased 157,900 157,900 reports................................
Pilot testing........................... 56,000 56,000
Usability testing of Webbased reports.. 56,300 56,300
Data collection via Knowledge Networks.. 126,000 126,000
Data analysis........................... 56,300 56,300
Preparation of reports and journal 112,600 112,600 papers.................................
AHRQ project management................. 110,000 110,000
Total............................... 844,000 844,000 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
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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: July 8, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E917203 Filed 72109; 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.