Attachment D -- 30 Day FR Notice -- Health Literacy

Federal Register / Vol. 74, No. 139 / Wednesday, July 22, 2009 / Notices
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: July 8, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9–17203 Filed 7–21–09; 8:45 am]
BILLING CODE 4160–90–M

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: ‘‘Health
Literacy Item Set Supplemental to
CAHPS Hospital Survey—Pretest of
Proposed 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 May 13th, 2009 and allowed
60 days for public comment. 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
burden hours are increased from 200 to
250, and (2) an incentive experiment
has been added.
DATES: Comments on this notice must be
received by August 21, 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 email 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.

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FOR FURTHER INFORMATION CONTACT:
Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427–1477, or by
e-mail at [email protected].
SUPPLEMENTARY INFORMATION:

Proposed Project
‘‘Health Literacy Item Set Supplemental
to CAHPS Hospital Survey—Pretest of
Proposed Questions and Methodology’’
AHRQ proposes to conduct a pretest
of the Consumer Assessment of
Healthcare Providers and Systems
(CAHPS®) Hospital Survey health
literacy module. The 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 to
generate tools and resources that
sponsors can use to produce
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 to meet the various needs of
health care consumers, purchasers,
health plans, providers, and
policymakers. Based on a literature
review and an assessment of currently
available questionnaires, AHRQ
identified the need to develop a health
literacy module for the CAHPS®
Hospital Survey. The intent of the
planned module is to examine patients’
perspectives on how well health
information is communicated to them
by healthcare professionals in the
hospital setting. The objective of the
new module is to provide information to
health plans, hospitals, clinicians, group
practices, and other interested parties
regarding the quality of health
information delivered to patients. The
set of questions about health literacy
will be evaluated as a supplement to the
CAHPS® Hospital Survey.
This study will be conducted for
AHRQ by its contractor, RAND
Corporation. It 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

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health care services. See 42 U.S.C.
299a(a)(1).
This study is a one-time field test to
be completed in the calendar years 2009
and 2010. The field test to be conducted
under this request will be done for the
following purposes:
a. Analysis of item wording—Assess
candidate wordings for items.
b. Analysis of participation rate—
Evaluate the overall response rate and
the proportion of that obtained from
mail versus telephone modes of data
collection.
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 of the
health literacy item set based on the
assessment of the reliability and
validity.
e. 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 collection of
the data related to the assessment of
patients’ perspective on how well health
information is communicated to them
by health care professionals in a
hospital setting. The field testing will
ensure that future data collections yield
high quality data and minimize
respondent burden, increase agency
efficiency, and improve responsiveness
to the public. The survey items will be
added to currently available CAHPS®
surveys and will enhance the ability of
hospitals to assess the quality of their
services.
Method of Collection
The potential respondent universe is
persons who had at least one overnight
stay at a hospital within the previous
five months. Excluded from the study
will be those who were less than 18
years old at the time of their admission,
had a psychiatric diagnosis, were
discharged to a hospice facility or died
during the hospitalization. Testing sites
will be selected purposively based on
several considerations, including ability
to execute the activities necessary to
participate in the pilot, number of beds,
number of discharges for medical,
surgical, and obstetric patients, average
length of stay, location (urban versus
rural), profit status, and academic
medical center status.
The draw will be a sample large
enough to yield approximately 600
completes. It is assumed that

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Federal Register / Vol. 74, No. 139 / Wednesday, July 22, 2009 / Notices

approximately 1,200 patients will be
sampled across all field sites with a
response rate of 50%. This pretest will
use a mixed mail-telephone mode of
data collection which will include the
following steps:
• Mailing an advanced notification
letter.
• Mailing of the questionnaire and
cover letter.
• Postcard reminder.
• A second mailing of the
questionnaire to non-respondents.
• Up to 10 telephone calls to every
mail non-respondent approximately two
weeks after the final mailing.
Every effort will be made to maximize
the response rate, while retaining the
voluntary nature of the effort. An
advance notice will be mailed prior to
mailing the survey and will include a
letter explaining what the survey is
about, who is doing it and why, and
providing contact information for
questions. The second mailing and
telephone follow-up are expected to
result in significant increases in
response. Every effort to maximize the
response rate among Spanish-speaking
respondents will be made. A Spanish
version of the advance notice, the
questionnaire, cover letters, and the

reminder card, as well as a Spanish
version of the telephone transcript has
been developed. The cover letters in
English include a note in Spanish
instructing respondents to call a toll free
number if they would like to receive a
copy of the survey in Spanish. In
addition, participating field sites will
ask for information on language
preference and/or race/ethnicity of
sample patients so that the mailing of
the survey can be tailored for Spanishspeakers.
Finally, phone follow-up to
respondents who do not complete the
survey by mail will be conducted by
bilingual interviewers so that those who
want to complete the survey by
telephone in either English or Spanish
can accommodated.
Surveys generally do not yield
complete responses from every
individual sampled from the
population. In this analysis, patterns of
both unit and item nonresponse will be
examined and modeled, and the
potential impact of nonresponse bias
assessed. A common set of
administrative variables (e.g., age,
gender, race/ethnicity) will be used to
predict unit nonresponse. These

variables and others collected on the
survey itself will be used as predictors
of item nonresponse. Case mix
adjustment and nonresponse weights
will be used to more accurately reflect
consumer experiences with health care
in the field test hospitals. Multivariate
logistic regression models will be used
to analyze the factors associated with
unit nonresponse and item
nonresponse.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated
annualized burden for the respondents’
time to participate in this data
collection. The CAHPS Hospital Survey
Health Literacy Module will be
completed by about 600 persons. The
estimated response time of 25 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 similar samples. The total burden
hours are estimated to be 250 hours.
Exhibit 2 shows the respondents’ cost
burden associated with their time to
participate in this data collection. The
total cost burden of completing pretest
is estimated to be $4,890.

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS
Number of
respondents

Form name

Number of
responses per
respondent

Hours per
response

Total burden
hours

Mail survey with reminder card, mail and phone follow-up .............................

600

1

25/60

250

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

600

1

na

250

EXHIBIT 2—ESTIMATED ANNUALIZED BURDEN HOURS
Number of
respondents

Form name

Total burden
hours

Average hourly wage rate*

Total cost
burden

Mail survey with reminder card, mail and phone follow-up .............................

600

250

$19.56

$4,890

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

600

250

na

4,890

*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

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The total cost for the contracted
service is approximately $245,000 and
the cost for AHRQ staff to oversee the
project is $50,000, including benefits.

The project was initiated in October of
2008 and it is forecasted that it will be
completed in 18 months. The initial
developmental work has been
completed within the first ten months of
the project and it is forecasted that the
pretest, analysis and finalization of the

Health Literacy Item Set supplemental
to CAHPS Hospital Survey can be
completed within the next eight
months. It is estimated that the total cost
of the project is approximately
$295,000. The annualized cost of the
project is approximately $196,669.

EXHIBIT 3—ESTIMATED COST
Cost component

Total cost

Review of literature ..................................................................................................................................................
Cognitive interviews .................................................................................................................................................
Field test ..................................................................................................................................................................

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$20,000
60,000
90,000

Annualized
cost
$13,334
40,000
60,000

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Federal Register / Vol. 74, No. 139 / Wednesday, July 22, 2009 / Notices
EXHIBIT 3—ESTIMATED COST—Continued
Cost component

Total cost

Annualized
cost

Data analyses ..........................................................................................................................................................
Finalize survey .........................................................................................................................................................
AHRQ project management ....................................................................................................................................

40,000
35,000
50,000

26,667
23,334
33,334

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

295,000

196,669

Request for Comments
In accordance with the above-cited
Paperwork Reduction Act legislation,
comments on AFIRQ’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: July 8, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9–17201 Filed 7–21–09; 8:45 am]
BILLING CODE 4160–90–M

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Submission for OMB review; Comment
Request
Title: National Survey of Child and
Adolescent Well-Being Second Cohort
(NSCAW II).
OMB No.: 0970–0202.
Description: The Department of
Health and Human Services (HHS)
intends to collect follow-up data on a
sample of children and families for the
National Survey of Child and
Adolescent Well-Being (NSCAW). The
NSCAW was authorized under section
427 of the Personal Responsibility and
Work Opportunities Reconciliation Act
of 1996. The NSCAW is the only source
of nationally representative, firsthand
information about the functioning and

well-being, service needs, and service
utilization of children and families who
come to the attention of the child
welfare system. Information is collected
about children’s cognitive, social,
emotional, behavioral, and adaptive
functioning, as well as family and
community factors that are likely to
influence their functioning. Family
service needs and service utilization
also are addressed in the data collection.
Selection of the current NSCAW
sample and baseline data collection
began in 2007 with a final anticipated
sample size of 5,700 children. The
proposed data collection will allow for
follow-up of this sample 18 months
post-baseline, and will follow the same
format as that used in the baseline
round and will employ, with only
modest revisions, the same instruments
that were used in the previous round.
Data from NSCAW are made available to
the research community through
licensing arrangements from the
National Data Archive on Child Abuse
and Neglect at Cornell University.
Respondents: Children and their
associated permanent or foster
caregivers, caseworkers, and teachers.

ANNUAL BURDEN ESTIMATES
Number of
respondents

Instrument

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Child Interview ...............................................................................................
Caregiver Interview ........................................................................................
Caseworker Interview ....................................................................................
Teacher Questionnaire ..................................................................................

Estimated Total Annual Burden
Hours: 5,882.
Additional Information: Copies of the
proposed collection may be obtained by
writing to the Administration for
Children and Families, Office of
Planning, Research and Evaluation, 370
L’Enfant Promenade, SW., Washington,
DC 20447, Attn: OPRE Reports
Clearance Officer. All requests should
be identified by the title of the
information collection. E-mail address:
[email protected].

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Number of
responses per
respondent

Average burden
hours per
response

1
1
3
1

1.33
1.9
1
.50

1,424
1,424
285
855

OMB Comment: OMB is required to
make a decision concerning the
collection of information between 30
and 60 days after publication of this
document in the Federal Register.
Therefore, a comment is best assured of
having its full effect if OMB receives it
within 30 days of publication. Written
comments and recommendations for the
proposed information collection should
be sent directly to the following: Office
of Management and Budget, Paperwork
Reduction Project, Fax: 202–395–6974,
Attn: Desk Officer for the

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Total burden
hours
1,894
2,706
855
428

Administration for Children and
Families.
Dated: July 16, 2009.
Seth F. Chamberlain,
OPRE Reports Clearance Officer.
[FR Doc. E9–17301 Filed 7–21–09; 8:45 am]
BILLING CODE 4184–01–M

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