Development and Evaluation of AHRQs Quality Indicators Improvement Toolkit

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #4 AHRQ QI Data Collection Tool	Form and Instruction	New	Available
Form Form #3 Usability Testing Protocol	Form and Instruction	New	Available
Form Form #2 Quarterly Update Protocol	Form and Instruction	New	Available
Form Form #1 Pre/Post-Test Interview Protocol	Form and Instruction	New	Repair queued
Supporting Statement Part B -- Development & Evaluation of AHRQs QI Indicators Toolkit 5-21-2010.doc	Supporting Statement B	Uploaded 2010-05-25	Available
Attachment C -- Toolkit principles and outline of contents 03-11-10.doc	Supplementary Document	Uploaded 2010-03-11	Available
Attachment I -- RAND IRB approval.pdf	Supplementary Document	Uploaded 2010-03-11	Repair queued
Attachment H -- Informed Consent for Pre-post intervw 05-19-10.doc	Supplementary Document	Uploaded 2010-05-25	Available
Attachment B -- 30 Day Federal Register Notice.pdf	Supplementary Document	Uploaded 2010-03-11	Available
Supporting Statement Part A -- Development & Evaluation of AHRQs QI Indicators Toolkit 5-21-2010.doc	Supporting Statement A	Uploaded 2010-05-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
192333	AHRQ QI Data Collection Tool	Form and Instruction	New
192332	Usability Testing Protocol	Form and Instruction	New
192331	Quarterly Update Protocol	Form and Instruction	New
192330	Pre/Post-Test Interview Protocol	Form and Instruction	New

ICR Details

OMB Control No: 0935-0164	ICR Reference No: 201003-0935-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Development and Evaluation of AHRQs Quality Indicators Improvement Toolkit
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: 06/15/2010
	Date Received in OIRA: 03/24/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2012	24 Months From Approved
Responses	228	0	0
Time Burden (Hours)	360	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: An important part of AHRQ's mission is to disseminate information and tools that can support improvement in quality and safety in the U.S. health care community. This proposed information collection supports that part of AHRQ's mission by developing and evaluating a toolkit that will enable hospitals to effectively use AHRQ's Quality Indicators (QIs). AHRQ has developed sets of QIs that can be used by the Agency and others to document quality and safety conditions at U.S. hospitals. Two sets of QIs will be used in this proposed toolkit: the Inpatient Quality Indicators (IQIs) and the Patient Safety Indicators (PSIs). The IQIs contain measures of volume, mortality, and utilization for common medical conditions and major surgical procedures. The PSIs are a set of measures to screen for potentially preventable adverse events that patients may experience during hospitalization. These QIs have been previously developed and evaluated by AHRQ, and are in use at a number of hospitals throughout the country. The QIs and supportive documentation on how to work with them are posted on AHRQ's Web site at www.qualityindicators.ahrq.gov. Many of the QIs have been endorsed by the National Quality Forum through its consensus review process.

---

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

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 69341	12/31/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 11540	03/11/2010
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Pre/Post-Test Interview Protocol	Form #1	Pre/Post-Test Interview Protocol
Quarterly Update Protocol	Form #2	Quarterly Update Protocol
Usability Testing Protocol	Form #3	Usability Testing Protocol
AHRQ QI Data Collection Tool	Form #4	AHRQ QI Data Collection Tool

---

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	228	0	0	228	0	0
Annual Time Burden (Hours)	360	0	0	360	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: This is a new information collection request.

---

Annual Cost to Federal Government: $104,914

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]? No

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

---

Common Form ICR:  No

---

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: 03/24/2010

---