Establishing Comparative Data for the Medical Office Survey on Patient Safety

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #3 Post-Survey Evaluation	Form and Instruction	New	Available
Form Form #2 Office Characteristics Survey	Form and Instruction	New	Available
Form Form #1 Medical Office Survey on Patient Safety	Form and Instruction	New	Available
Document.pdf	Supplementary Document	Uploaded 2009-05-08	Available
Attachment D -- Post-Survey Evaluation.doc	Supplementary Document	Uploaded 2009-05-07	Available
Supporting Statement Part B -- Establishing Comparative Data for the MOSOPS 05-06-09.doc	Supporting Statement B	Uploaded 2009-05-07	Available
Attachment A -- Healthcare Research and Quality Act of 1999.pdf	Supplementary Document	Uploaded 2008-12-16	Available
Supporting_Statement_Part_A_--_Establishing_Comparative_Data_for_the_MOSOPS_05-06-09[1]	Supporting Statement A	Uploaded 2009-05-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
187580	Post-Survey Evaluation	Form and Instruction	New
187579	Office Characteristics Survey	Form and Instruction	New
187578	Medical Office Survey on Patient Safety	Form and Instruction	New

ICR Details

OMB Control No: 0935-0148	ICR Reference No: 200812-0935-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Establishing Comparative Data for the Medical Office Survey on Patient Safety
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: 05/11/2009
	Date Received in OIRA: 12/17/2008
Terms of Clearance: This ICR is approved consistent with AHRQ memo of 4-20-09 and revised supporting statement and instruments. Use of a purposive sample is approved consistent with an understanding that this is a temporary solution to the need for comparative data that medical offices can use to assess their relative performance, until such time as the database is sufficiently populated with responses from a wide variety of medical offices throughout the country.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2010	12 Months From Approved
Responses	8,400	0	0
Time Burden (Hours)	2,100	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: AHRQ requests that the Office of Management and Budget approve, under the Paperwork Reduction Act of 1995, AHRQ's intention to (1) collect information needed to establish reliable benchmarks for the Medical Office Survey on Patient Safety and (2) collect descriptive information on barriers and facilitators to survey participation by medical offices, and on the utility/value of survey data in improving ambulatory patient safety. The ambulatory Medical Office Survey on Patient Safety (MO-SOPS), an adapted version of AHRQ's Hospital Survey on Patient Safety Culture (HSOPSC), was developed in 2005 to measure specific factors of patient safety culture in the ambulatory setting. A pilot study (OMB #0935-0131) assessed and refined the psychometric properties of specific survey items, and a final version of MO-SOPS is now ready for public dissemination (see Attachment B). However, in order for the survey to be useful to ambulatory medical offices in identifying areas of relative strength and weakness in patient safety culture, reliable benchmarks to which a practice's responses can be compared need to be established.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act 0f 1999
  

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:
	73 FR 54402	09/19/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 74723	12/09/2008
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Medical Office Survey on Patient Safety	Form #1	Medical Office Survey on Patient Safety
Office Characteristics Survey	Form #2	Office Characteristics Survey
Post-Survey Evaluation	Form #3	Post-Survey Evaluation

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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	8,400	0	0	8,400	0	0
Annual Time Burden (Hours)	2,100	0	0	2,100	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: Submission of a new proposed information collection.

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Annual Cost to Federal Government: $308,000

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)? No

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: 12/17/2008

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