[Federal Register Volume 79, Number 131 (Wednesday, July 9, 2014)]
[Notices]
[Pages 38901-38903]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-15806]
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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: ``Taking Efficiency Interventions in Health Services Delivery
to Scale.'' In accordance with the Paperwork Reduction Act of 1995,
AHRQ invites the public to comment on this proposed information
collection.
This proposed information collection was previously published in
the Federal Register on April 8th, 2014, 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.
DATES: Comments on this notice must be received by August 8, 2014.
ADDRESSES: Written comments should be submitted to: Doris Lefkowitz,
Reports Clearance Officer, AHRQ, by email at
[email protected].
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 email at
[email protected].
SUPPLEMENTARY INFORMATION:
Proposed Project
Taking Efficiency Interventions in Health Services Delivery to Scale
The primary care workforce is facing imminent clinician shortages
and increased demand. With the implementation of the Affordable Care
Act (ACA), Federally Qualified Health Centers (FQHCs) are expected to
play a major role in addressing the large numbers of people who become
eligible for health insurance as well as continue in their role as
safety net providers. Thus, understanding new models of service
delivery and improving efficiency within FQHCs is of national policy
import. The proposed data collection supports the goal of developing a
more efficient FQHC service delivery model through studying outcomes
associated with a ``delegate model,'' which is designed to improve
provider and team efficiency, and the spread of this model throughout a
large FQHC.
Recent models of practice transformation have documented the use of
an Organized Team Model that distributes responsibility for patient
care among an interdisciplinary team, thereby allowing physicians to
manage a larger panel size while practicing high quality care. The
delegate model requires that all team members perform
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at the top of their skill level, and that tasks currently performed by
clinicians are delegated to non-clinician team members in a safe and
effective manner. Researchers at the University of California, San
Francisco have estimated that delegation may allow physicians to
increase their panel size by shifting tasks to non-physician team
members. More specifically, if portions of preventive and chronic care
services are delegated to non-physicians, primary care practices can
meet recommended quality and care guidelines while maintaining panel
sizes with a limited primary care physician workforce. This study will
examine the real-world implementation of such a model in order to build
evidence of whether such delegation can achieve the predicted increases
in panel sizes.
AHRQ is working with John Snow, Inc. (JSI) and its partner,
Penobscot Community Health Center (PCHC), to evaluate the effectiveness
and spread of a delegate model in 5 of PCHC's 15 primary care service
sites. The model will be spread from an initial pilot physician-medical
assistant team to other clinics, as well as to other teams within each
clinic. PCHC is an FQHC located in Bangor, Maine that serves
northeastern Maine.
Currently, PCHC's primary care providers (PCPs, which include
medical doctors, osteopaths, nurse practitioners, and physician
assistants) each work with a Medical Assistant (MA). Under the delegate
model, a pair of PCPs will be assigned an ``administrative'' MA to
enhance their team. This position will enable shifting of
responsibilities among the team, with the intent of relieving the PCPs
of administrative tasks and incorporating new tasks that will enhance
team efficiency. Examples of tasks that an administrative MA may take
on include standardized prescription renewals, schedule management, in-
box management, scribing, pre-visit planning with pre-appointment
laboratory tests, and identification of patients for ancillary
referrals (e.g., behavioral health and case management).
This study has the following goals:
(1) To evaluate the spread and effectiveness of the delegate model
in five of PCHC's primary care sites;
(2) To evaluate the influence of the delegate model on provider
satisfaction, team functioning, and patient satisfaction;
(3) To assess the contextual factors influencing the above
outcomes; and
(4) To disseminate findings.
This study is being conducted by AHRQ through its contractor, JSI,
pursuant to AHRQ's statutory authority to conduct and support research
on health care and on systems for the delivery of such care, including
activities with respect to the quality, effectiveness, efficiency,
appropriateness and value of health care services and with respect to
quality measurement and improvement. 42 U.S.C. 299a(a)(1) and (2).
Method of Collection
AHRQ seeks approval for the following data collection activities:
Team Survey that will be disseminated to all members of
both delegate and non-delegate primary care teams to assess job
satisfaction and team functioning in all participating sites at two
points in time.
Key Informant Interviews conducted with staff in each of
the participating sites during two rounds of site visits, with key
informants to include the Medical Director, Practice Director, members
of primary care teams implementing the delegate model, and ancillary
staff. A condensed version of the interview will be used for a
conference call with each participating site's Medical Director and
Practice Director as an interim activity between the two site visits.
The information yielded from this study is expected to inform a
wide cross section of audiences and stakeholders about provider
efficiency, practice redesign, team-based care, workforce strategies,
and spread of an innovation. This study is not intended to make broad
generalizations about the effectiveness of the delegate model of care,
but rather to build initial evidence about this promising new model,
its ability to increase panel size in FQHCs, and provide guidance on
how similar models might be spread and evaluated.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden for the
respondents' time to participate in this research. Information will be
collected through an internet-based team survey and in-person and
telephone interviews. Note that some respondents may be double-counted,
so the total number of respondents may be less than 80. For example, a
respondent may fill out a survey as well as participate in a phone
interview.
Exhibit 2 shows the estimated annualized cost burden associated
with the respondents' time to participate in this research. The total
annual cost burden is estimated to be $25,151.
Exhibit 1--Estimated Annualized Burden Hours
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Number of
Form name Number of responses per Hours per Total burden
respondents respondent response hours
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Team Survey:
-Providers.................................. 21 2 15/60 11
-Other Clinical Staff....................... 34 2 15/60 17
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Total................................... 55 2 15/60 28
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Key Informant Interviews (Site visits):
-Medical Director........................... 2 2 30/60 2
-Practice Director.......................... 2 2 30/60 2
-Providers.................................. 5 2 30/60 5
-Other Clinical Staff....................... 10 2 30/60 10
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Total................................... 19 2 30/60 19
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Key Informant Interviews (Phone calls):
-Medical Director........................... 3 1 1 3
-Practice Director.......................... 3 1 1 3
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Total................................... 6 1 1 6
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Total............................... 80 na na 53
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Exhibit 2--Estimated Annualized Cost Burden
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Number of Total burden Average hourly Total cost
Form name respondents hours wage rate * burden
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Team Survey:
--Providers................................. 21 11 \a\ $62.13 14,352
--Other Clinical Staff...................... 34 17 \b\ 14.69 8,491
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Total................................... 55 28 na 22,843
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Key Informant Interviews (Site Visit):
--Medical Director.......................... 2 2 \c\ 92.08 368
--Practice Director......................... 2 2 \d\ 47.34 189
--Providers................................. 5 2 \a\ 62.13 621
--Other Clinical Staff...................... 10 2 \b\ 14.691 294
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Total................................... 19 8 na 1,472
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Key Informant Interviews (Phone calls):
--Medical Director.......................... 3 2 \c\ 92.08 552
--Practice Director......................... 3 2 \d\ 47.34 284
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Total................................... 6 4 na 836
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Total............................... 80 na na 25,151
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* National Compensation Survey: Occupational wages in the United States May 2012, ``U.S. Department of Labor,
Bureau of Labor Statistics.''
\a\ Based on the average mean wages for three categories of primary care provider ($92.08--MDs; $44.45 PAs; and
$43.97--NPs).
\b\ Based on the mean wage of Medical Assistants.
\c\ Based on the mean wages for MDs.
\d\ Based on the mean wages for Medical and Health Services Managers.
\e\ Based on the mean wages for Data Analyst (Computer and Information Analyst).
Request for Comments
In accordance with the Paperwork Reduction Act, 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: June 25, 2014.
Richard Kronick,
AHRQ Director.
[FR Doc. 2014-15806 Filed 7-8-14; 8:45 am]
BILLING CODE 4160-90-M