REQUEST FOR APPROVAL OF PILOT OF THE HCAHPS/SHEP SATISFACTION SURVEY INSTRUMENTS, VA FORMS OF THE 10-21083(NR) SERIES

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-21083a(NR) PILOT OF THE HCAHPS/SHEP SATISFACTION SURVEY INSTRUMENTS	Form	New	Available
VA 8 10-21083d.pdf	Supplementary Document	Uploaded 2008-01-30	Available
VA 7 10-21083c(1).pdf	Supplementary Document	Uploaded 2008-01-30	Available
VA 6 10-21083b.pdf	Supplementary Document	Uploaded 2008-01-30	Available
VA 6 10-21083b.pdf	Supplementary Document	Uploaded 2008-01-30	Available
VA 5 10-21083e.pdf	Supplementary Document	Uploaded 2008-01-30	Available
VA 3 justification_HCHAPS_Pilot_102407.doc	Supplementary Document	Uploaded 2008-01-30	Available
VA 2 Fixing HCAHPS pilot for OMB.doc	Supplementary Document	Uploaded 2008-01-30	Available
VA 1 Eight-way pilot tables.pdf	Supplementary Document	Uploaded 2008-01-30	Available
Justification Part A[1].doc	Supporting Statement A	Uploaded 2007-07-24	Available
Justification Part B.doc	Supporting Statement B	Uploaded 2007-07-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
181241	PILOT OF THE HCAHPS/SHEP SATISFACTION SURVEY INSTRUMENTS	Form	New

ICR Details

OMB Control No: 2900-0707	ICR Reference No: 200707-2900-039
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: REQUEST FOR APPROVAL OF PILOT OF THE HCAHPS/SHEP SATISFACTION SURVEY INSTRUMENTS, VA FORMS OF THE 10-21083(NR) SERIES
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/30/2008
	Date Received in OIRA: 07/24/2007
Terms of Clearance: Approved with VA response to OMB questions and comments including revisions to language addressing confidentiality.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2009	36 Months From Approved
Responses	7,250	0	0
Time Burden (Hours)	3,625	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Joint Commission on the Accreditation of Hospital Organizations (JCAHO) is poised to adopt the Hospital Consumer Assessment of Health Plan Survey (HCAHPS) as a national standard survey for inpatients and VA needs to conform with private sector surveys to the extent possible so that VA can have a means of comparing customer service performance with comparable non-VA healthcare facilities nationwide. On December 12, 2005, OMB approved the HCAHPS survey instrument for use by the Agency for Healthcare Research and Quality (AHRQ) under approval number 0938-0981. However, before Veterans Health Administration (VHA) implementation, it is necessary to test the possible consequences of using the HCAHPS alone versus in combination similar questions on the existing Veterans Health Administration (VHA) Survey of Healthcare Experiences of Patients (SHEP) Inpatient survey (approved under 2900-0227). The SHEP contains a broader range of questions mandated by Congress. A series of five pilots is proposed to develop the future patient satisfaction survey for hospitalized veterans.

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Authorizing Statute(s): US Code: 38 USC 527 Name of Law: Evaluation and data collection
   EO: EO 12862 Name/Subject of EO: SETTING CUSTOMER SERVICE STANDARDS
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 134	07/13/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 141	07/24/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
PILOT OF THE HCAHPS/SHEP SATISFACTION SURVEY INSTRUMENTS	10-21083d(NR), 10-21083b (NC), 10-21083e(NR), 10-21083c(NR), 10-21083a(NR)	HCAHPS Survey ,   HCAHPS survey plus SHEP items not covered in HCAHPS ,   HCAHPS and full SHEP Inpatient survey ,   Current SHEP Inpatient document in 2 column format ,   Current SHEP Inpatient document in 1 column format

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	7,250	0	0	7,250	0	0
Annual Time Burden (Hours)	3,625	0	0	3,625	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Pilot results will determine content and survey methods for future rounds of customer satisfaction surveys. VHA proposes a five-part piloting of the HCAPHS survey instrument to better understand how this questionnaire (either alone or combined with all or part of VHA’s current inpatient questionnaire) will perform in measuring patient satisfaction, and what will be the effect on response rate. In addition, we intend to determine how the HCAHPS sampling methods work in the population of Veteran inpatients, and how those results may differ from current methods. This pilot study is designed to obtain baseline results on how veteran patients respond to healthcare related questions using the HCAHPS survey, and modified versions as compared to responses to similar questions on the existing Survey of Healthcare Experiences of Patients (SHEP) Inpatient survey (approved under 2900-0227), to identify and test methods for maintaining the ability to validly trend performance results should VHA pursue adopting HCAHPS as the standard survey for inpatients. The purpose of the pilots is to prepare VA to conform to future AHRQ standards for Medicare claims. The purpose of these patient satisfaction surveys is to determine how to improve services, customer satisfaction with existing services and how or if customer satisfaction has changed in response to reengineering efforts. The results will be used by management at all levels as a tool for assessing and improving the quality of services being provided to patients. Patient satisfaction scores are part of the evaluation system for senior VHA managers.

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Annual Cost to Federal Government: $109,139

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/24/2007

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