[Federal Register Volume 76, Number 220 (Tuesday, November 15, 2011)]
[Pages 70723-70726]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-29383]



Agency for Healthcare Research and Quality

Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.


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: ``Assessing the Feasibility of Disseminating Effective Health 
Center Products through Mobile Phone Applications.'' In accordance with 
the Paperwork Reduction Act, 44 U.S.C. 3501-3521, AHRQ invites the 
public to comment on this proposed information collection.

DATES: Comments on this notice must be received by January 17, 2012.

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.

Clearance Officer, (301) 427-1477, or by email at 
[email protected].


Proposed Project

Assessing the Feasibility of Disseminating Effective Health Center 
Products Through Mobile Phone Applications

    The Agency for Healthcare Research and Quality (AHRQ) requests that 
the Office of Management and Budget (OMB) approve, under the Paperwork 
Reduction Act of 1995, this collection of information from users of 
work products and services initiated by the John M. Eisenberg Clinical 
Decisions and Communications Science Center (Eisenberg Center).
    AHRQ is the lead agency charged with supporting research designed 
to improve the quality of healthcare, reduce its cost, improve patient 
safety, decrease medical errors, and broaden access to essential 
services. AHRQ's Eisenberg Center's mission is improving communication 
of findings to a variety of audiences (``customers''), including 
consumers, clinicians, and health care policy makers. The Eisenberg 
Center compiles research results into useful formats for customer 
stakeholders. The Eisenberg Center also conducts investigations into 
effective communication of research findings in order to improve the 
usability and rapid incorporation of findings into medical practice. 
The Eisenberg Center is one of three components of AHRQ's Effective 
Health Care (EHC) Program. The collections proposed under this 
clearance include activities to assess the

[[Page 70724]]

feasibility of using specific media and awareness-raising processes to 
encourage consumers who are at risk for selected health problems for 
which EHC Program materials are available to access information about 
such materials using mobile phone technologies. The project will 
specifically focus on promoting awareness of eight consumer guides 
developed through the EHC Program. The guides are all published in 
English and Spanish-language versions. All of the guides are designed 
to help decision makers, including clinicians and health care 
consumers, use research evidence to maximize the benefits of health 
care, minimize harm, and optimize the use of health care resources.
    The project will test the feasibility of using mobile telephone 
technology for the dissemination of EHC Program materials to 
underserved health consumer populations using: (a) Short message 
services (SMS), usually referred to as texting, that can be provided to 
people with basic cell phone service and texting support; and (b) 
mobile Web access that provides access to the Internet via a mobile 
    Different methods and/or vehicles will be used to promote awareness 
of opportunities to obtain cell phone- or smart phone-based information 
about the availability of EHC Program materials including: (1) Wall 
posters in patient service areas of the three (3) participating 
clinics; (2) flyers about the products distributed in magazine racks 
and through patient kiosks in some areas of the clinics; (3) flyers/
announcements given to patients at checkout from the clinic; and (4) 
health fairs convened to address general health issues, where the 
information can be provided. Promotional materials will invite 
potential users to send a specific text message with the keyword 
associated with the relevant health condition to the advertised number. 
Subjects will receive a response text with a brief message about the 
condition and an invitation to either (a) request a printed consumer 
guide or (b) access the mobile Web site to view the guide.
    This project has the following goals:
    (1) Summarize marketing efforts in terms of total numbers of 
posters, flyers, and information sheets distributed through specific 
venues (e.g., patient waiting areas, patient check-out processes) and 
numbers of individuals contacted through health fairs and related 
    (2) Summarize the extent to which persons in targeted patient 
populations responded to marketing efforts;
    (3) Assess patient satisfaction with: (a) The means by which 
patients were alerted as to the availability of EHC Program materials; 
(b) the methods patients used to request and access the EHC Program 
materials; and (c) the value and relevancy of the information that they 
    (4) Characterize perceptions of clinical care providers and 
clinical staff persons in terms of: (a) The value of efforts to promote 
patient awareness of EHC Program materials using marketing techniques 
described in this feasibility project; and (b) the effect of these 
efforts on workflow issues and related aspects of clinic operations.
    This study is being conducted by AHRQ through its contractor, the 
Eisenberg Center--Baylor College of Medicine, pursuant to AHRQ's 
statutory authority to conduct and support research, and disseminate 
information, on healthcare and on systems for the delivery of such 
care, including activities with respect to both the quality, 
effectiveness, efficiency, appropriateness and value of healthcare 
services and clinical practice. 42 U.S.C. 299a(a)(1) and (4).

Method of Collection

    To achieve the goals of this project the following data collections 
will be implemented:
    (1) Focus Groups with Clinicians. A focus group will be conducted 
at each of the three participating clinics during regularly scheduled 
internal clinic meetings, to determine how the introduction of 
marketing materials and related resources influenced, if at all, 
delivery of care in the clinical settings. Special emphasis will be 
placed on determining if introduction of the project materials changed 
the ways in which patients interacted with clinicians. It is expected 
that each focus group will include no more than 10 clinical 
professionals (e.g., physicians, physician assistants, nurses and nurse 
practitioners, pharmacists).
    (2) Focus Groups with Support Staff. A focus group will be 
conducted with support staff working in each of the three participating 
clinics, during regularly scheduled meetings, to determine if the 
introduction of the project materials altered clinic workflows. It is 
expected that each focus group will include no more than 12 support 
staff (e.g., receptionists, nursing assistants, other personnel who 
interact with patients).
    (3) Patient Interviews. In-person interviews conducted immediately 
after the patient exits the clinic will be used to determine if 
patients: (a) Saw and understood the marketing materials (e.g., posters 
and flyers) in clinic settings; (b) were encouraged by the marketing 
materials to text and request information about their health issue(s); 
(c) could identify specific reasons why they did or did not text; and 
(d) have suggestions about how marketing materials might be changed so 
that they would be more likely to encourage patients like themselves to 
    (4) Feedback Questionnaire for Patients Requesting Mailed Guides. 
All persons that respond to the marketing materials by requesting any 
of the eight guides to be mailed to them will be asked to complete a 
brief paper questionnaire included with the guides. The purpose of the 
questionnaire is to assess the extent to which the guides were easy to 
read and understand, whether the guides provided the information they 
sought, and any suggestions for improving and delivering the guides.
    (5) Feedback Questionnaire for Patients Visiting the Mobile Web 
Site. All persons that access the guides via the mobile Web site will 
be asked to complete a brief online questionnaire. Only subjects 
exposed to the promotion materials will receive the address of the 
mobile Web site during the text message conversation, and therefore we 
expect no other individuals to visit this site. The purpose of the 
questionnaire is to determine if the guides were useful, the mobile Web 
site was easy to use, whether they found the information they needed 
and experienced any difficulty in accessing the guides through their 
cell phone.
    (6) Usage Log Data. Data from automated electronic log systems will 
be collected from two sources: (1) Mobile Commons, the contractor that 
manages the cell phone-related message delivery and cell phone-based 
communication; and (2) the Eisenberg Center at Baylor College of 
Medicine that manages the EHC Web site visits. Usage log data gathered 
from the cell phone service contractor will include: (1) Counts of text 
messages received from persons requesting information about consumer 
guides; (2) the distribution of message counts across originating 
clinics tracked through the use of distinctive call-in or short code 
numbers assigned to each clinic; and (3) the numbers and originating 
clinic-specific distributions of follow-up texts. Because text 
communications will be date and time stamped, Eisenberg Center staff 
will be able to calculate mean durations in time from receipt of the 
initial messages and follow-ups, which may be useful in determining 
navigation patterns and suggesting connectivity barriers. Usage log 
data gathered from the mobile Web site will allow for identification 
of: (1) The number of visitors that originate

[[Page 70725]]

from a specific uniform record locator (URL) associated with each 
clinic; (2) the duration of visits to the EHC Web site to gather 
desired information and explore other resources available through the 
Web site; (3) the number of pages viewed by each visitor; and (4) the 
number of downloads of the full report associated with each guide, 
which will also be made available. These data will be obtained using 
automated systems already in place, and no special effort will be 
needed to generate these data; this task is not included in the burden 
estimates in Exhibit 1 below.
    The Eisenberg Center will determine the feasibility of this 
approach to encouraging patients and anyone else viewing the marketing 
materials to access information that may be helpful to them in 
understanding health care choices and engaging more fully in their own 
health care, and whether this approach should be pursued further. This 
information will be used to determine the feasibility of: (a) Mounting 
broader efforts to distribute consumer guides, as well as other EHC 
Program products, using mobile technologies as tools to heighten 
awareness of these resources by potential users who rely on mobile 
communication devices for information access; and (b) initiating 
additional studies to identify factors that encourage or deter 
effective use of increasingly pervasive communication modalities (e.g., 
cell phones, smart phones) in communicating with care providers and 
others and to access information from the Internet and health-related 
Web sites.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden for the 
respondents' time to participate in this research. Focus groups will be 
conducted with about 10 clinicians per each of the 3 participating 
clinics (30 total) and about 12 clinical support staff per clinic (36 
total), and will last 45 minutes. Interviews will be conducted with 
about 100 patients per clinic (300 total) upon exit from the clinical 
visit, with each interview lasting about 15 minutes. The Feedback 
Questionnaire for the Mailed Guides will be completed by approximately 
200 persons and will take 10 minutes to complete, and the Feedback 
Questionnaire for the Mobile site will be completed by about 200 
persons and also requires 10 minutes to complete. The total annual 
burden is estimated to be 191 hours.
    Exhibit 2 shows the estimated annualized cost burden associated 
with the respondent's time to participate in this research. The total 
annual cost burden is estimated to be $5,320.

                               Exhibit 1--Estimated Annualized Total Burden Hours
                                                                     Number of
             Type of data collection                 Number of     responses per     Hours per     Total burden
                                                    respondents     respondent       response          hours
Focus Groups with Clinicians....................              30               1           45/60              23
Focus Groups with Support Staff.................              36               1           45/60              27
Patient Interviews..............................             300               1           15/60              75
Feedback Questionnaire for Patients Requesting               200               1           10/60              33
 Mailed Guides..................................
Feedback Questionnaire for Patients Visiting                 200               1           10/60              33
 Mobile Web site................................
    Total.......................................             766              na              na             191

                                Exhibit 2--Estimated Annualized Total Cost Burden
                                                     Number of     Total burden   Average hourly    Total cost
             Type of data collection                respondents        hours        wage rate*        burden
Focus Groups with Clinicians....................              30              23          $83.59          $1,923
Focus Groups with Support Staff.................              36              27           14.31             386
Patient Interviews..............................             300              75           21.35           1,601
Feedback Questionnaire for Patients Requesting               200              33           21.35             705
 Mailed Guides..................................
Feedback Questionnaire for Patients Visiting....             200              33           21.35             705
Mobile Web site.................................
    Total.......................................             766             191              na          5,320
* Based upon the mean wages for clinicians (29-1062 family and general practitioners), clinical team members (31-
  9092 medical assistants) and consumers (00-0000 all occupations), National Compensation Survey: Occupational
  wages in the United States May 2010, ``U.S. Department of Labor, Bureau of Labor Statistics.''

Estimated Annual Costs to the Federal Government

    The maximum cost to the Federal Government is estimated to be 
$203,531 annually. Exhibit 3 shows the total and annualized cost by the 
major cost components.

             Exhibit 3--Estimated Total and Annualized Cost
          Cost component                Total cost      Annualized cost
Project Development...............           $146,175            $73,088
Data Collection Activities........             85,425             42,713
Data Processing and Analysis......             65,375             32,688
Project Management................             47,588             23,794

[[Page 70726]]

Overhead..........................             62,500             31,250
    Total.........................            407,063            203,531

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 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: November 3, 2011.
Carolyn M. Clancy,
[FR Doc. 2011-29383 Filed 11-14-11; 8:45 am]