Attachment D -- 30 Day Federal Register Notice

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Federal Register / Vol. 74, No. 114 / Tuesday, June 16, 2009 / Notices

Request for Comments
Written comments and/or suggestions
from the public and affected agencies
are invited on one or more of the
following points: (1) Whether the
proposed collection of information is
necessary for the proper performance of
the agency, including whether the
information will have practical utility;
(2) The accuracy of the agency’s
estimate of the proposed collection of
information, including the validity of
the methodology and assumptions used;
(3) Ways to enhance the quality, utility,
and the clarity of information to be
collected; and (4) Ways to minimize the
burden of the collection of information
on those who are to respond, including
the use of appropriate automated,
electronic, mechanical, or other
technological collection techniques or
other forms of information technology.
FOR FURTHER INFORMATION CONTACT: To
request more information on the
proposed project or to obtain a copy of
the data collection plans and
instruments, contact: Steven Alves,
Website Programs Specialist, Office of
Intramural Training and Education, OD,
NIH, Building 2, Room 2E06, 2 Center
Drive MSC 0240, Bethesda, MD 20892–
0240, or call non-toll-free number 301–
402–1294, or e-mail your request,
including your address to:
[email protected].
Comments Due Date: Comments
regarding this information collection are
best assured of having their full effect if
received within 60 days of the date of
this publication.
Dated: June 9, 2009.
Sharon Milgram,
Director, Office of Intramural Training &
Education, National Institutes of Health.
[FR Doc. E9–14156 Filed 6–15–09; 8:45 am]
BILLING CODE 4140–01–P

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Agency for Healthcare Research and
Quality
Agency Information Collection
Activities: Proposed Collection;
Comment Request

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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: ‘‘CAHPS
Field Test of Proposed Health

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Information Technology Questions and
Methodology.’’ In accordance with the
Paperwork Reduction Act of 1995,
Public Law 104–13 (44 U.S.C.
3506(c)(2)(A)), AHRQ invites the public
to comment on this proposed
information collection.
This proposed information collection
was previously published in the Federal
Register on March 31, 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. This notice
differs from the 60-day notice in the
following ways: (1) The number of
respondents has been increased from
4,800 to 7,200; (2) the burden hours are
increased from 1,600 to 2,400; (3) an
incentive experiment has been added;
and (4) an experiment testing the use of
a 4-point vs. 6-point response scale has
been added.
DATES: Comments on this notice must be
received by July 16, 2009.
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
‘‘CAHPS Field Test of Proposed Health
Information Technology Questions and
Methodology’’
The Consumer Assessment of
Healthcare Providers and Systems
(CAHPS®) program is a multi-year
initiative of the Agency for Healthcare
Research and Quality. AHRQ first
launched the program in October 1995
in response to concerns about the lack
of good information about the quality of
health plans from the enrollees’
perspective. Numerous public and
private organizations collected
information on enrollee and patient
satisfaction, but the surveys varied from
sponsor to sponsor and often changed
from year to year. The CAHPS®
program was designed to:
• Make it possible to compare survey
results across sponsors and over time;
and
• Generate tools and resources that
sponsors can use to produce

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understandable and usable comparative
information for consumers.
Over time, the program has expanded
beyond its original focus on health
plans to address a range of health care
services and meet the various needs of
health care consumers, purchasers,
health plans, providers, and
policymakers. Based on the literature
review and an assessment of currently
available survey instruments, AHRQ
identified the need to develop a new
health information technology module
of the CAHPS® survey. The intent of the
planned module is to examine in greater
detail than previously patients’
perspective on health information
technology use by their health care
professionals. The intent of the new
module is to provide information to
clinicians, group practices, health plans,
and other interested parties regarding
the impact of the use of health
information technology on patients’
experiences with care. The set of
questions about health information
technology will be tested as a part of
CAHPS® Clinician & Group Survey,
Adult Primary Care Questionnaire.
This study, funded through
cooperative agreements with RAND and
Harvard, is being conducted pursuant to
AHRQ’s statutory authority to conduct
research and evaluations on health care
and systems for the delivery of such
care, including activities with respect to
(1) the quality, effectiveness, efficiency,
appropriateness and value of health care
services and (2) health care
technologies, facilities and equipment.
See 42 U.S.C. 299a(a)(1) and (5).
This study is a one-time field test to
be conducted in calendar year 2009.
The field test to be conducted under this
request will be done for the following
purposes:
a. Analysis of revised item wording—
Assess candidate wordings for survey
items.
b. Mode Analysis—Evaluate the
equivalence of items administered by
mail, telephone, and Internet; compare
the characteristics and responses of
respondents who complete the survey
by different modes of administration.
c. Case mix adjustment analysis—
Evaluate variables that need to be
considered for case mix adjustment of
scores.
d. Psychometric Analysis—Provide
information for the revision and
shortening of questionnaires based on
the assessment of the reliability and
validity of survey items and composites.
e. Test a 4-point vs. a 6-point response
scale—The CAHPS Clinician & Group
Survey will test both a 4-point response
scale (Never, Sometimes, Usually,
Always) and a 6-point response scale

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Federal Register / Vol. 74, No. 114 / Tuesday, June 16, 2009 / Notices
(Never, Almost Never, Sometimes,
Usually, Almost Always, Always). For
those sites already employing the 6point response scale, a subset of
questions will be repeated using the 4point scale. This will allow comparison
of item performance within a site across
both versions of the response scale, and
collect data that can be used to inform
comparison of data collected using the
two versions of the response scales.
f. Incentive experiment—Provide
information on the effectiveness of a
post-paid, $5 incentive as a mechanism
to enhance response by randomizing
half the sample at one site to an
experiment in which a post-paid
incentive of $5 is provided for
completing the survey.
The end result will be a data
collection related to the assessment of
patients’ perspective on how well health
information technology is being used by
health care professionals. The field
testing will ensure that the future data
collection yields high quality data and
to ensure a minimization of respondent
burden, increase agency efficiency, and
improve responsiveness to the public.
The survey items will be added to
currently available CAHPS® surveys
and will provide a venue to clinicians
and practitioners to verify the quality of
their services.
Method of Collection
Respondents will be selected from six
purposively chosen sites (health care
providers and health insurance plans)
that have implemented health
information technology systems, such as
electronic health records (EHRs) and
electronic prescription refills, that are
used by sufficient numbers of enrollees
(i.e., at least 2400 enrollees per site).
From each site the potential respondent
universe will be patients who have been
receiving care from a clinician at the
health provider for at least one year
prior to the survey and who have used

one or more features of the health
providers’ EHR system. EHR systems
managers have the ability to track which
patients log on to the system, and which
features (e.g., examine lab results,
request prescription refill, etc.) the
patients used. The sample selection at
each site will be carried out jointly by
senior leadership at the site (e.g., chief
information officer) and a survey vendor
experienced in conducting the CAHPS
survey. We will ask the sites to provide
a list of their enrollees who have seen
a provider in the last 12 months and
who have logged onto the EHR system
in the last 12 months. We will randomly
select a sample of these enrollees for the
field test. We will use common
statistical techniques to select the
sample, e.g., computerized random
number generation applied to a list of
enrollees. When possible, we will
stratify the enrollees at a site based on
extent of HIT exposure to ensure a mix
of different enrollees in the study (e.g.,
enrollees who use many HIT functions
versus those who use few HIT
functions). Institutional Review Boards
(IRBs) at Harvard and RAND evaluated
the study to ensure proper protection of
patients’ right to privacy and
confidentiality as well as avoidance of
harm. The study received approvals
from both IRBs.
The draw will be a sample large
enough to yield approximately 7,200
respondents. Because we are assuming a
50% response rate, we will draw
approximately 14,400 patients to
achieve our total of 7,200 respondents.
Sites to be selected will meet the
following requirements:
• As much geographic distribution as
possible;
• Substantial number of patients with
exposure to health information
technology.
We anticipate a mixed mail-telephone
mode of data collection which will
include the following steps:

• Mailing an advance notification
letter;
• Mailing of the questionnaire and
cover letter;
• Postal card reminder;
• A second mailing of the
questionnaire to non-respondents;
• Minimum of six telephone calls to
every mail non-respondent
approximately two weeks after the final
mailing to complete a telephone
interview.
We will also administer the survey by
internet to some of the study
participants. For those assigned to
internet administration an e-mail
invitation will be sent that includes an
invitation to participate along with a
URL link to a web-based survey hosted
on a secure server. Sites will be divided
between RAND’s Survey Research
Group and the Center for Survey
Research, University of Massachusetts,
Boston (CSR). RAND will use the
software CfMC to administer the survey,
while CSR will use Snap software.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated
annualized burden for the respondents’
time to participate in this data
collection. The CAHPS® Clinician &
Group Survey, Adult Primary Care
Questionnaire will be completed by
about 7,200 persons. The estimated
response time of 20 minutes is based on
the written length of the survey and
AHRQ’s experience with previous
CAHPS® surveys of comparable length
that were fielded with a similar,
although not identical, population. The
total burden hours are estimated to be
2,400 hours.
Exhibit 2 shows the respondents’ cost
burden associated with their time to
participate in this data collection. The
total cost burden is estimated to be
$46,944.

EXHIBIT 1. ESTIMATED ANNUALIZED BURDEN HOURS
Number of
respondents

Form Name

Number of
responses per
respondent

Hours per
response

Total burden
hours

CAHPS® Clinician & Group Survey, Adult Primary Care Questionnaire .......

7,200

1

20/60

2,400

Total ..........................................................................................................

7,200

1

na

2,400

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EXHIBIT 2. ESTIMATED ANNUALIZED COST BURDEN
Number of
respondents

Form Name
CAHPS® Clinician & Group Survey, Adult Primary Care Questionnaire .......

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Total burden
hours

7,200

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2,400

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Average
hourly wage
rate*
$19.56

Total cost burden
$46,944

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Federal Register / Vol. 74, No. 114 / Tuesday, June 16, 2009 / Notices
EXHIBIT 2. ESTIMATED ANNUALIZED COST BURDEN—Continued
Number of
respondents

Form Name
Total ..........................................................................................................

Total burden
hours

7,200

Average
hourly wage
rate*

2,400

na

Total cost burden
46,944

*Based upon the average wages, ‘‘National Compensation Survey: Occupational Wages in the United States, May 2007,’’ U.S. Department of
Labor, Bureau of Labor Statistics.

Estimated Annual Costs to the Federal
Government
The total cost to the Federal
Government for developing the Health
Information Technology questions, and
testing them within the CAHPS®
Clinician & Group Survey, Adult
Primary Care Questionnaire, is
$780,000, including the cost of
reviewing the literature, conducting
focus groups and cognitive interviews,
field testing the instrument, analyzing
the data, finalizing the survey, preparing
reports, writing papers for journal
submission, and project management
(see Exhibit 3). Data collection will not
exceed one year.

EXHIBIT 3. ESTIMATED ANNUAL COST
Cost component

Total cost

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Review of literature .......................
Focus groups ................................
Cognitive interviews ......................
Field test .......................................
Data analyses ...............................
Finalize survey ..............................
Preparation of reports and journal
papers .......................................
AHRQ project management .........

$35,000
60,000
80,000
260,000
80,000
50,000

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 4, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9–14080 Filed 6–15–09; 8:45 am]
BILLING CODE 4160–90–P

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.

SUMMARY: This notice announces the
intention of the Agency for Healthcare
Research and Quality (AHRQ) to request
Total .......................................
780,000 that the Office of Management and
Budget (OMB) approve the proposed
information collection project: ‘‘2010–
Request for Comments
2011 Medical Expenditure Panel Survey
In accordance with the above-cited
Insurance Component.’’ In accordance
Paperwork Reduction Act legislation,
with the Paperwork Reduction Act of
comments on AHRQ’s information
1995, 44 U.S.C. 3506(c)(2)(A), AHRQ
collection are requested with regard to
invites the public to comment on this
any of the following: (a) Whether the
proposed information collection.
proposed collection of information is
necessary for the proper performance of DATES: Comments on this notice must be
AHRQ health care research and health
received by August 17, 2009.
care information dissemination
ADDRESSES: Written comments should
functions, including whether the
be submitted to: Doris Lefkowitz,
information will have practical utility;
Reports Clearance Officer, AHRQ, by e(b) the accuracy of AHRQ’s estimate of
mail at [email protected].
burden (including hours and costs) of
Copies of the proposed collection
the proposed collection(s) of
plans, data collection instruments, and
information; (c) ways to enhance the
specific details on the estimated burden
quality, utility, and clarity of the
can be obtained from the AHRQ Reports
information to be collected; and (d)
Clearance Officer.
ways to minimize the burden of the
collection of information upon the
FOR FURTHER INFORMATION CONTACT:
respondents, including the use of
Doris Lefkowitz, AHRQ Reports
automated collection techniques or
Clearance Officer, (301) 427–1477, or by
other forms of information technology.
e-mail at [email protected].
Comments submitted in response to
this notice will be summarized and
SUPPLEMENTARY INFORMATION:

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85,000
130,000

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Proposed Project
2010–2011 Medical Expenditure Panel
Survey Insurance Component
AHRQ seeks to renew the Medical
Expenditure Panel Survey Insurance
Component (MEPS–IC) for calendar
years 2010 and 2011. The MEPS–IC, an
annual survey of the characteristics of
employer-sponsored health insurance,
was first conducted by AHRQ in 1997
for the calendar year 1996. The survey
has since been conducted annually for
calendar years 1996 through 2009,
except for 2007. A change from prior
year collection to calendar year
collection in 2008 meant that no data
were collected for the 2007 calendar
year, but the change has allowed for
much earlier release of the survey
results for the 2008 calendar year
forward. AHRQ is authorized to conduct
the MEPS–IC pursuant to 42 U.S.C.
299b-2.
Employment-based health insurance
is the source of coverage for over 90
million workers and their family
members, and is a cornerstone of the
current U.S. health care system. The
MEPS–IC measures the extent, cost, and
coverage of employment-based health
insurance. Statistics are produced at the
National, State, and sub-State
(metropolitan area) level.
The MEPS–IC is designed to provide
data for Federal policymakers
evaluating the effects of National and
State health care reforms. It also
provides descriptive data on the current
employment-based health insurance
system and data for modeling the
differential impacts of proposed health
policy initiatives. The MEPS–IC also
supplies critical State and National
estimates of health insurance spending
for the National Health Accounts and
Gross Domestic Product. Data to be
collected from each employer will
include a description of the organization
(e.g., size, industry) and descriptions of
health insurance plans available, plan
enrollments, total plan costs and costs
to employees. This survey will be
conducted for AHRQ by the Bureau of
the Census using an annual sample of
employers selected from Census Bureau
lists of private sector employers and
governments.

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