Avoiding Readmissions in Hospitals Serving Diverse Patients

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #10 Intensive training guide	Form and Instruction	New	Available
Form Form #9 Master trainer training guide	Form and Instruction	New	Available
Form Form #8 Attachment I - Hospital system variables 12 15 10	Form and Instruction	New	Available
Form Form #8 Medical record review variables	Form and Instruction	New	Available
Form Form #7 Patient Questionnaire	Form and Instruction	New	Available
Form Form #6 Patient questionnaire	Form and Instruction	New	Available
Form Form #5 Post implementation semi-structured interview protocol	Form and Instruction	New	Available
Form Form #4 Base-line semi-structured interview protocol	Form and Instruction	New	Available
Form Form #3 Monthly semi-structured interview protocol	Form and Instruction	New	Available
Form Form #2 Baseline key contact semi-structured interview protocol	Form and Instruction	New	Available
Form Form #1 Baseline Needs Assessment Guide	Form and Instruction	New	Available
Supporting Statement PART B-- Avoiding Readmissions 12 15 2010.doc	Supporting Statement B	Uploaded 2010-12-21	Available
Attachment N -- Response to Public Comment.doc	Supplementary Document	Uploaded 2010-09-08	Available
Attachment L -- Federal Register Notice.pdf	Supplementary Document	Uploaded 2010-09-08	Available
Attachment B -- Electronic template for the After Hospital Care Plan (example) .doc	Supplementary Document	Uploaded 2010-09-08	Available
Attachment A -- Healthcare Research and Quality Act of 1999.pdf	Supplementary Document	Uploaded 2010-09-08	Available
Supporting Statement PART A -- Avoiding Readmissions 12 15 10 Response to OMB.doc	Supporting Statement A	Uploaded 2010-12-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
194758	Intensive training	Form and Instruction	New	Intensive training guide
194757	Master trainer training	Form and Instruction	New	Master trainer training guide
194756	Medical record review	Form and Instruction	New	Attachment I - Hospital system variables 12 15 10
194756	Medical record review	Form and Instruction	New	Medical record review variables
194755	Administration of patient survey by hospital staff	Form and Instruction	New	Patient Questionnaire
194754	Patient survey	Form and Instruction	New	Patient questionnaire
194753	Post implementation semi-structured interview	Form and Instruction	New	Post implementation semi-structured interview protocol
194752	Base-line semi-structured interview	Form and Instruction	New	Base-line semi-structured interview protocol
194751	Monthly semi-structured interview	Form and Instruction	New	Monthly semi-structured interview protocol
194750	Baseline key contact semi-structured interview	Form and Instruction	New	Baseline key contact semi-structured interview protocol
194749	Baseline needs assessment	Form and Instruction	New	Baseline Needs Assessment Guide

ICR Details

OMB Control No: 0935-0173	ICR Reference No: 201009-0935-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Avoiding Readmissions in Hospitals Serving Diverse Patients
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: 12/22/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/30/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2012	18 Months From Approved
Responses	12,904	0	0
Time Burden (Hours)	6,126	0	0
Cost Burden (Dollars)	0	0	0

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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. The transition process from the hospital to the outpatient setting is nonstandardized and frequently inadequate in quality. One in five hospital discharges is complicated by an adverse event (AE) within 30 days, often leading to an emergency department visit and/or rehospitalization. Many readmissions stem from errors that can be directly attributed to the discontinuity and fragmentation of care at discharge. High rates of low health literacy, lack of coordination in the "hand-off" from the hospital to community care, gaps in social supports, and other limitations also contribute to the risk of rehospitalization.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 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:
	75 FR 35038	06/21/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 53306	08/31/2010
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
Administration of patient survey by hospital staff	Form #7	Patient Questionnaire
Base-line semi-structured interview	Form #4	Base-line semi-structured interview protocol
Baseline key contact semi-structured interview	Form #2	Baseline key contact semi-structured interview protocol
Baseline needs assessment	Form #1	Baseline Needs Assessment Guide
Intensive training	Form #10	Intensive training guide
Master trainer training	Form #9	Master trainer training guide
Medical record review	Form #8, Form #8	Medical record review variables ,   Attachment I - Hospital system variables 12 15 10
Monthly semi-structured interview	Form #3	Monthly semi-structured interview protocol
Patient survey	Form #6	Patient questionnaire
Post implementation semi-structured interview	Form #5	Post implementation semi-structured interview protocol

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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	12,904	0	0	12,904	0	0
Annual Time Burden (Hours)	6,126	0	0	6,126	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.

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Annual Cost to Federal Government: $299,984

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]? No

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: 09/30/2010

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