[Federal Register Volume 75, Number 47 (Thursday, March 11, 2010)]
[Notices]
[Pages 11540-11542]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-4948]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Agency for Healthcare Research and Quality, HHS.
ACTION: Notice.
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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: ``Development and Evaluation of AIIRQ's Quality Indicators
Improvement Toolkit.'' In accordance with the Paperwork Reduction Act,
44 U.S.C. 3501-3520, AHRQ invites the public to comment on this
proposed information collection.
This proposed information collection was previously published in
the Federal Register on December 31st, 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.
DATES: Comments on this notice must be received by April 12, 2010.
ADDRESSES: Written comments should be submitted to: AHRQ's OMB Desk
Officer by fax at (202) 395-6974 (attention: AHRQ's desk officer) or by
e-mail at [email protected] (attention: AHRQ's desk
officer).
Copies of the proposed collection plans, data collection
instruments, and specific details on the estimated burden can be
obtained from the AHRQ Reports Clearance Officer.
FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427-1477, or by e-mail at
[email protected].
SUPPLEMENTARY INFORMATION:
Proposed Project
Development and Evaluation of AHRQ's Quality Indicators Improvement
Toolkit
An important part of AHRQ's mission is to disseminate information
and tools that can support improvement in quality and safety in the
U.S. health care community. See 42 U.S.C. 299(b)(1)(F); 299a(a)(1) and
(2). This proposed information collection supports that part of AHRQ's
mission by developing and evaluating a toolkit that will enable
hospitals to effectively use AHRQ's Quality Indicators (QIs).
AHRQ has developed sets of QIs that can be used by the Agency and
others to document quality and safety conditions at U.S. hospitals. Two
sets of QIs will be used in this proposed toolkit: the Inpatient
Quality Indicators (IQIs) and the Patient Safety Indicators (PSIs). The
IQIs contain measures of volume, mortality, and utilization for common
medical conditions and major surgical procedures. The PSIs are a set of
measures to screen for potentially preventable adverse events that
patients may experience during hospitalization. These QIs have been
previously developed and evaluated by AHRQ, and are in use at a number
of hospitals throughout the country. The QIs and supportive
documentation on how to work with them are posted on AHRQ's Web site at
http://www.qualityindicators.ahrg.gov. Many of the QIs have been
endorsed by the National Quality Forum through its consensus review
process.
Values for each QI can be estimated for a given hospital by
applying computations in SAS programs developed by AHRQ to the
hospital's pre-existing inpatient encounter data. To identify potential
areas for improving the quality and safety of the care that a hospital
provides, the hospital can use these data to examine its current
performance on each QI measure, changes in its performance over time,
and how its performance compares to that of other hospitals. However,
despite the availability of the QIs as tools to help hospitals assess
their performance, many U.S. hospitals
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have limited experience with the use of such measurement tools, or in
using quality improvement methods to improve their performance as
assessed by these measures.
An alpha version of the Quality Indicators Improvement Toolkit will
be developed, which then will be field tested by six hospitals. During
the field test, the proposed evaluation will assess the usability of
the Toolkit for hospitals, and it will examine their experiences in
implementing interventions to improve their performance on the AHRQ
QIs, as well as effects on trends in the hospitals' AHRQ QI values.
Using results from the evaluation, the alpha Toolkit will be revised to
yield a final Toolkit that will be effective in supporting hospitals'
quality improvement efforts.
The development and evaluation of the Quality Indicators
Improvement Toolkit will be conducted by AHRQ's contractor, the RAND
Corporation, under contract number HHSA290200600017I. RAND has
subcontracted with the University HealthSystem Consortium (UHC) to
partner in the development of the Toolkit and field testing of it with
hospitals as they use the Toolkit in carrying out initiatives designed
to improve performance on the QIs.
Method of Collection
Case study research methods will be used for this qualitative
study. The following four data collection instruments will be used in
the evaluation:
(1) Pre/post-test interview protocol--Consisting of both open- and
closed-ended questions will be administered prior to implementation of
the Toolkit and again post implementation. The purpose of this data
collection is to obtain data on the steps the hospitals took to
implement actions to improve performance on the QIs; their plans for
making process changes; and their experiences in achieving changes and
perceptions regarding lessons learned that could be shared with other
hospitals.
(2) Update protocol--Consisting of both open- and closed-ended
questions will be administered three times during the study (quarterly
during the implementation year). The purpose of this data collection is
to capture longitudinal data regarding hospitals' progress in
implementing changes, successes and challenges, and plans for
subsequent actions. These data will include descriptive information on
changes over time in the hospitals' implementation actions and how they
are using the Toolkit, as well as experiential information on the
perceptions of participants regarding the improvement implementation
process and its effects. It also ensures the collection of information
close to pertinent events, which avoids the recall bias associated with
retrospective reporting of experiences.
(3) Usability testing protocol--Also consisting of both open and
closed ended questions will be administered once at the end of the
evaluation period. The purpose of this data collection is to gather
information from the hospitals on how they used each tool in the
Toolkit, the ease of use of each tool, which tools were most helpful,
suggested changes to improve each tool, and suggestions for other tools
to add to the Toolkit. This information will be used in the revisions
of the Toolkit following the end of the field test.
(4) AHRQ QI data collection tool--Used to collect the IQI and PSI
measures calculated by the hospitals both prior to implementation of
the Toolkit and again post implementation. The purpose of this data
collection is to determine if the hospitals' implementation actions,
including use of the toolkit, had a measurable impact on the QI
measures.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
respondents' time to participate in this information collection. Three
protocols will be used to collect data from respondents in interviews
that will take one hour each. The pre/post-test interview protocol will
be administered twice--at the beginning and end of the field-test year.
The pre- test interviews will be performed as one-hour group interviews
conducted with the six hospitals' implementation teams at the start of
the year. At the end of the year, post-test interviews will be
performed as one-hour group interviews with three of the hospitals and
during site visits with the other three hospitals. At each site visit,
data will be collected through one-hour interviews with the hospital's
implementation team as well as through other group interviews performed
separately with each of the key stakeholder groups--physicians, nurses,
clerks, and others. The additional data from the stakeholder groups
will allow triangulation of variations in perceptions and experiences
among different groups, of which the implementation teams might not be
aware.
The quarterly update protocol will be administered quarterly to 2
hospital staff members from each hospital during the year (in months 3,
6, and 9). The usability testing protocol will be administered to 4
staff members once at the end of the evaluation period. The AHRQ QI
data collection tool will be used both pre- and post-implementation to
collect the QI measures. The total burden is estimated to be 360 hours.
Exhibit 2 shows the estimated annualized cost burden associated
with the respondents' time to participate in the evaluation. The total
cost burden is estimated to be $9,886.
Exhibit 1--Estimated Annualized Burden Hours
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Number of
Form name Number of responses per Hours per Total burden
hospitals hospital response hours
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Pre/Post-Test Interview Protocol................ 6 26 1 156
Quarterly Update Protocol....................... 6 6 1 36
Usability Testing Protocol...................... 6 4 1 24
AHRQ QI Data Collection Tool.................... 6 2 *12 144
Total....................................... 24 NA NA 360
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* Includes time to program and run the computer programs necessary to produce the measures.
[[Page 11542]]
Exhibit 2--Estimated Annualized Cost Burden for Hospitals
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Number of Total burden Average hourly Total cost
Form name hospitals hours wage rate* burden
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Pre/Post-Interview Protocol..................... 6 156 $27.46 $4,284
Quarterly Update Protocol....................... 6 36 27.46 989
Usability Testing Protocol...................... 6 24 27.46 659
AHRQ QI Data Collection Tool.................... 6 144 27.46 3,954
Total....................................... 24 360 NA 9,886
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* Based upon the mean of the average wages, National Compensation Survey: Occupational wages in the United
States, March 2009, ``U.S. Department of Labor, Bureau of Labor Statistics.'' Used as an overall average wage
rate across the various types of staff involved in the quality improvements.
Estimated Annual Costs to the Federal Government
Exhibit 3 shows the estimated total and annualized cost of this
project to the government. The estimated total cost for the evaluation
work is $209,827 over the two-year year project, with an annualized
total cost of $104,914. These costs were developed based on estimates
of staff days required, to which administrative expenses are applied,
and based on airfare, hotel, and per diem costs for staff travel for
the site visits at the end of the evaluation.
Exhibit 3--Estimated Cost of the Evaluation
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Annualized
Cost component Total cost cost
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Protocol Development.................... $40,278 $20,139
Data Collection Activities.............. 91,104 45,552
Data Analysis........................... 45,252 22,626
Publication of Results.................. 24,370 12,185
Travel for Site Visits.................. 8,823 4,412
Total............................... 209,827 104,914
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Request for Comments
In accordance with the above-cited 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 healthcare research and healthcare 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 24, 2010.
Carolyn M. Clancy,
Director.
[FR Doc. 2010-4948 Filed 3-10-10; 8:45 am]
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