Attachment N -- Federal Register Notice

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Federal Register / Vol. 76, No. 58 / Friday, March 25, 2011 / Notices
via e-mail, and may include a telephone
non-response follow-up. Telephone
non-response follow-up for mailed
surveys is not counted as a telephone
survey in Exhibit 1. Not more than 600
persons, over 3 years, will participate in
telephone surveys that will take about
40 minutes. Web-based surveys will be
conducted with no more than 3,000
persons and will require no more than

10 minutes to complete. About 1,500
persons will participate in focus groups
which may last up to two hours, while
in-person interviews will be conducted
with 600 persons and will take about 1
hour. Automated data collection will be
conducted for about 1,500 persons and
could take up to 1 hour. Cognitive
testing will be conducted with about
600 persons and is estimated to take 1⁄2;

hours to complete. The total burden
over 3 years is estimated to be 8,900
hours (about 2,967 hours per year).
Exhibit 2 shows the estimated cost
burden over 3 years, based on the
respondent’s time to participate in these
research activities. The total cost burden
is estimated to be $298,239.

EXHIBIT 1—ESTIMATED BURDEN HOURS OVER 3 YEARS
Number of
respondents

Type of information collection

Number of
responses per
respondent

Hours per
response

Total burden
hours

Mail/e-mail * ..............................................................................................
Telephone ................................................................................................
Web-based ...............................................................................................
Focus Groups ..........................................................................................
In-person ..................................................................................................
Automated ** ............................................................................................
Cognitive Testing *** ................................................................................

6,000
600
3,000
1,500
600
1,500
600

1
1
1
1
1
1
1

20/60
40/60
10/60
2.0
1.0
1.0
1.5

2,000
400
500
3,000
600
1,500
900

Totals ................................................................................................

13,800

na

na

8,900

* May include telephone non-response follow-up in which case the burden will not change.
** May include testing of database software, CAPI software or other automated technologies.
*** May include cognitive interviews for questionnaire or toolkit development, or ‘‘think aloud’’ testing of prototype Web sites.

EXHIBIT 2—ESTIMATED COST BURDEN OVER 3 YEARS
Number of
respondents

Type of information collection

Total burden
hours

Average wage
rate *

Total cost
burden

Mail/e-mail ................................................................................................
Telephone ................................................................................................
Web-based ...............................................................................................
Focus Groups ..........................................................................................
In-person ..................................................................................................
Automated ................................................................................................
Cognitive Testing .....................................................................................

6,000
600
3,000
1,500
600
1,500
600

2,000
400
500
3,000
600
1,500
900

$33.51
33.51
33.51
33.51
33.51
33.51
33.51

$67,020
13,404
16,755
100,530
20,106
50,265
30,159

Totals ................................................................................................

13,800

8,900

na

298,239

* Based upon the average wages for 29–000 (Healthcare Practitioner and Technical Occupations), ‘‘National Compensation Survey: Occupational Wages in the United States, May 2009,’’ U.S. Department of Labor, Bureau of Labor Statistics.

Estimated Annual Costs to the Federal
Government
Information collections conducted
under this generic clearance will in
some cases be carried out under
contract. Assuming four data collections
per year (either mail/e-mail, telephone,
Web-based or in-person) at an average
cost of $150,000 each, and two focus
groups, automated data collections or
lab experiments at an average cost of
$20,000 each, total contract costs could
be $640,000 per year.

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Request for Comments
In accordance with the above-cited
Paperwork Reduction Act legislation,
comments on AHRQ’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 healthcare research and

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healthcare 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.

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Dated: March 15, 2011.
Carolyn M. Clancy,
Director.
[FR Doc. 2011–6855 Filed 3–24–11; 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
Agency for Healthcare Research
and Quality, HHS.
ACTION: Notice.
AGENCY:

This notice announces the
intention of the Agency for Healthcare
Research and Quality (AHRQ) to request

SUMMARY:

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that the Office of Management and
Budget (OMB) approve the proposed
information collection project:
‘‘Connecting Primary Care Practices with
Hard-to-Reach Adolescent Populations.’’
In accordance with the Paperwork
Reduction Act, 44 U.S.C. 3501–3521,
AHRQ invites the public to comment on
this proposed information collection.
This proposed information collection
was previously published in the Federal
Register on January 13th, 2011 and
allowed 60 days for public comment. No
comments were received. The purpose
of this notice is to allow an additional
30 days for public comment.
DATES: Comments on this notice must be
received by April 25, 2011.
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.
FOR FURTHER INFORMATION CONTACT:
Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427–1477, or by
e-mail at
[email protected].
SUPPLEMENTARY INFORMATION:

Proposed Project

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Connecting Primary Care Practices With
Hard-to-Reach Adolescent Populations
The overall goal of this exploratory
project is to improve the quality of
adolescent health care. The project will
address suboptimal adolescent care with
respect to health risk behaviors, which
can have serious health consequences.
In particular, failure to address health
risk behaviors among adolescents (e.g.,
smoking, substance abuse, poor diets,
physical inactivity, and high-risk sexual
behavior) contributes significantly to
increased morbidity and mortality.
Adolescents (11–17 years of age)
constitute 17% of the population of the
U.S., but they are responsible for only
7% of medical office visits. As a result,
primary care providers have relatively
less opportunity to evaluate and counsel
adolescents in their offices than most
other patients. Even when adolescents
receive routine health care, open
communication with their health care
providers may be problematic. A
national survey found that the majority
of adolescent boys and girls in the
U.S. report at least 1 of 8 potential
health risks, but most (63%) had not
spoken to their doctor about any of

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these (Klein & Wilson, 2002). Improved
engagement and communication
between adolescents and their primary
care providers could increase the
likelihood that effective preventive
services and health care are provided. It
could also improve the efficiency of
health care services for adolescents, in
terms of appointments kept and
adherence to recommended screening or
treatment recommendations.
Technological interventions to
improve care may be particularly
appropriate for adolescents, since they
are typically the early adopters of new
technology (Skinner, Biscope, Poland, &
Goldberg, 2003). Use of in-office
electronic screeners before
appointments has proven useful (Olson,
Gaffney, Lee, &Starr 2008; Salerno,
2008; Yi, Martyn, Salerno, & DarlingFisher,). Outside of the office, youth
have increasingly turned to the internet
for health-related information, and have
also rapidly adopted mobile technology
(Lenhart. Line, Campbell. & Purcell,
2010) and social media (Lenhart,
Purcell, Smith& Zickuhr, 2010). Health
plans (e.g., Kaiser Permanente) and
practices (Hawn, 2009) have conducted
early work in applying patient-centered
web and mobile technologies. These
projects have included interventions to
decrease patient no-show rates, increase
the use of sunscreen, and engage
adolescents in diabetes management.
Much work remains to be done,
however, in understanding how primary
care practices can best embrace
advances in communications and
information technology to improve
health outcomes for adolescent patients.
This project has the following goals:
(1) Explore the benefits of
supplementing an electronic in-office
pre-visit screener with a set of Web
technologies for adolescent outreach
and engagement outside of office visits.
a. The Rapid Assessment for
Adolescent Preventive Services©
(RAAPS), as described below, will be
used for in-office pre-visit screening.
b. The Web technologies will include
(i) a Web page for more static content
such as information about practices and
health-related commentary from
practice clinicians and staff, (ii) a
Facebook page for social interaction
about health topics including topical
content that will engage adolescents in
conversations about general, not
personal, health behaviors and
encouraging youth to discuss these
issues with their primary care
practitioners at clinic visits, and (iii) a
Twitter site that will allow youth to use
mobile phones with text messaging to
subscribe to Facebook posts.

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(2) Increase adolescent visits to
primary care and identification of health
risks during visits.
(3) Promote healthier behavior in four
domains: (1) Diet, (2) physical activity,
(3) substance abuse (smoking, alcohol,
and use of other recreational drugs), and
(4) sexual health.
(4) Develop a manual of best practices
for these components in primary care.
This study is being conducted by
AHRQ through its contractor, State
Network of Colorado Ambulatory
Practices and Partners (SNOCAP–USA),
a practice-based research network
(PBRN) based at the University of
Colorado Denver, pursuant to AHRQ’s
statutory authority to conduct and
support research on healthcare and on
systems for the delivery of such care,
including activities with respect to the
quality, effectiveness, efficiency,
appropriateness and value of healthcare
services and with respect to clinical
practice, including primary care and
practice-oriented research. 42 U.S.C.
299a(a)(1) and (4).
Method of Collection
This project will be conducted in four
primary care practice sites that have a
substantial number of adolescent
patients. The following activities and
data collections will be implemented:
(1) RAAPS questionnaire. Practices
will use the 21-item RAAPS
questionnaire for in-office pre-visit
screening. RAAPS was developed by the
University of Michigan Regional
Alliance for Healthy Schools to elicit
information about risky adolescent
behaviors that should be addressed, but
often are missed, in primary care. It is
available in both paper and online
forms; the latter will be used in this
project. The primary purpose of the
RAAPS questionnaire is to improve
clinical recognition of risky behaviors so
that personal counseling may be
provided.
(2) Process measures for web
technologies. For each of the web
technologies used (the web page,
Facebook page, and Twitter site), data
on the number of unique visitors, the
frequency of their visits, and their
activities (e.g. whether they create a new
post or ‘‘like’’ postings) will be obtained
by the research team. These data will
not include personally identifiable
information (e.g. the user’s username,
birth date, IP address, etc.). OMB
clearance is not required for this data
collection.
(3) Extraction of medical record data.
Staff members at each practice will use
their clinical information systems to
extract medical record data for use by
the research team. Data to be extracted

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consist of (a) Contact information for
patients seen in the 18 months prior to
the start date for implementation of
RAAPS and the web technologies. This
is the sample frame for the adolescent
behavior and communication survey.
These data will be used by the project
staff to prepare the recruitment
mailings. (b) Clinic notes for adolescents
seen in the 12 months prior to
implementation start date and for
adolescents seen in the 12 months
following the implementation start date.
Clinic notes will be made accessible
either by pulling paper charts or
printing notes from electronic medical
records. The notes will be reviewed and
abstracted by the research team to assess
whether the intervention had the
intended effect of increasing adolescent
visits to primary care and the
identification of potential health risks
during visits.
(4) Consent-assent form. This is used
to obtain consent from the parent or
guardian and assent from the adolescent
to participate in the adolescent behavior
and communication survey.
(5) Adolescent behavior and
communication survey. A questionnaire
(by mail, with an online option) will be
administered twice to adolescent
patients for whom consent-assent has
been obtained: Once at baseline and
again six months after the intervention.
The purpose of this survey is to measure
the adolescent’s level of comfort with
discussing their health with their
clinician and their level of satisfaction
with their medical care, and to see how
this changes after the intervention.
(6) Post-visit satisfaction survey.
Practices will provide adolescents with
a brief, post-card sized anonymous
questionnaire at every office visit during
the study period. The purpose is to
assess the perceived utility of the
RAAPS questionnaire, and whether the
visit was related to the project’s web
technologies.
(7) Adolescent focus groups. Eight
adolescents (two from each practice)
will provide feedback on the web page,
Facebook, and Twitter pages. There will
be one in-person group meeting preimplementation, followed by a series of
3 additional asynchronous group
discussions conducted via the web at
three-month intervals. These provide a
process for user-centered design and
refinement of the of web technologies.

(8) Adolescent ‘‘think-aloud’’ sessions.
These sessions, which will be
conducted near the end of the study
period, will involve a set of eight
adolescent patients (two from each
practice) that did not participate in the
focus groups. Subjects will come to the
practice for individual sessions in
which they will be asked to say aloud
what they are thinking about the web
technologies as they navigate them as
they typically would. The purpose is to
assess the perceived utility of the
components of the web, Facebook, and
Twitter pages.
(9) Clinician semi-structured
interviews. At each site, individual
interviews will be conducted with two
clinicians (eight clinicians total). The
purpose is to assess clinician
perceptions of the effects of the RAAPS
questionnaire and the web technologies
on the clinical encounter and the care
they provide.
(10) Administrator-staff semistructured interviews. At each site,
semi-structured interviews will be
conducted with the practice manager
and a front-desk staff member. The
purpose is to assess the effect of the
interventions on the check in process
and other business processes.
(11) Semi-structured interviews for
the draft manual. The draft manual of
best practices in primary care for
adoption of web and assessment
technologies (such as the RAAPS
questionnaire) developed by the
research team will be sent to the
practice manager and the practice
director (lead clinician) of each site.
Their feedback will be solicited by
telephone roughly two weeks later. This
‘‘member checking’’ enhances the
validity of the manual’s conclusions and
recommendations.
The results from this exploratory
project will be used to inform
development of a manual to assist
primary care practices in adopting
interventions to improve the
effectiveness of their outreach to and
interactions with adolescent patients. In
addition, information collected in the
RAAPS questionnaire may be used by
clinicians to improve clinical care.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated
annualized burden hours for the
respondents’ time to participate in this

research. Among the 776 adolescent
patients across the 4 participating
practices, 310 are expected to complete
the RAAPS questionnaire, which takes
about 12 minutes to complete, at each
office visit (on average there will be an
estimated 1.25 office visits per patient).
Practice staff members will perform the
extraction of medical record data preimplementation, and again postimplementation, for 50 patients. This
task is estimated to require 4 hours per
practice (slightly less than 5 minutes per
patient record).
The consent-assent form for
participation in the adolescent behavior
and communication survey will be sent
to the homes of all adolescents in the
practice’s panels. The estimated average
time for reading and responding to the
form is 15 minutes. The adolescent
behavior and communication survey
will be completed twice, pre and post
intervention, by 186 adolescent patients
and requires 15 minutes to complete.
The post-visit satisfaction survey will be
completed by each of the 310
participating adolescent patients after
each office visit and will take 1 minute
to complete.
A series of four focus groups will be
held with 8 adolescent patients over the
course of the study period with each
session lasting about 1.5 hours. In
addition to the focus groups one ‘‘think
aloud’’ session will be held with a group
of 8 adolescent patients and will also
take 1.5 hours.
Feedback from the practice staff and
the clinicians will be obtained through
3 different semi-structured interviews.
Two staff members from each of the 4
practices will participate in these
interviews. The clinician and
administrator-staff semi-structured
interviews will each last 30 minutes.
Semi-structured interviews for the draft
manual will require about one hour total
(30 minutes to review the manual and
30 minutes to participate in the
interview). The total annualized burden
is estimated to be 479 hours.
Exhibit 2 shows the estimated
annualized cost burden associated with
the respondents’ time to participate in
this research. The total annual cost
burden is estimated to be $7,980.

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS
Number of
respondents

Activity/data collection
RAAPS questionnaire ......................................................................................
Extraction of medical record data ....................................................................

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Number of
responses per
respondent

310
4

E:\FR\FM\25MRN1.SGM

1.25
2

25MRN1

Hours per
response
12/60
4

Total
burden
hours
78
32

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Federal Register / Vol. 76, No. 58 / Friday, March 25, 2011 / Notices
EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS—Continued
Number of
respondents

Activity/data collection

Number of
responses per
respondent

Total
burden
hours

Hours per
response

Consent-assent form .......................................................................................
Adolescent behavior and communication survey ............................................
Post-visit satisfaction survey ............................................................................
Adolescent focus groups .................................................................................
Adolescent ‘‘think-aloud’’ sessions ..................................................................
Clinician semi-structured interviews ................................................................
Administrator-staff semi-structured interviews .................................................
Semi-structured interviews for the draft manual ..............................................

776
186
310
8
8
4
4
4

1
2
1.25
4
1
2
2
2

15/60
15/60
1/60
1.5
1.5
30/60
30/60
1

194
93
6
48
12
4
4
8

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

1,614

na

na

479

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN
Number of
respondents

Activity/data collection cost

Total
burden
hours

Average hourly wage rate 1

Total
burden

RAAPS questionnaire ......................................................................................
Extraction of medical record data ....................................................................
Consent-assent form .......................................................................................
Adolescent behavior and communication survey ............................................
Post-visit satisfaction survey ............................................................................
Adolescent focus groups .................................................................................
Adolescent ‘‘think-aloud’’ sessions ..................................................................
Clinician semi-structured interviews ................................................................
Administrator-staff semi-structured interviews .................................................
Semi-structured interviews for the draft manual ..............................................

310
4
776
186
310
8
8
4
4
4

78
32
194
93
6
48
12
4
4
8

2 $9.01

7 64.75

$703
581
4,289
838
54
432
108
338
119
518

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

1,614

479

na

7,980

3 18.15
4 22.11
2 9.01
2 9.01
2 9.01
2 9.01
5 84.53
6 29.63

1 Mean

hourly and wage costs for Colorado were derived from the Bureau of Labor and Statistics National Compensation Survey for May 2009
(http://www.bls.gov/oes/current/oes_co.htm).
2 Hourly rate for an entry level worker (occupation code 35–0000) estimates the cost of time for adolescents, although many will not be employed.
3 Hourly rate for medical records and health information technician (29–2071).
3 Hourly rate for medical records and health information technician (29–2071).
4 Hourly rate for the mean for all occupations (00–0000) estimates the cost of time for the parent or guardian of the adolescent.
5 Average of hourly rates for a family medicine practitioner (29–1062) and a general internist (29–1063).
6 Average of (1) the hourly rate for a medical and health services manager (11–9111) and (2) the average of the hourly rates for a receptionist
(43–4171) and a medical assistant (31–9092).
7 Average of (1) the hourly rate for a medical and health services manager (11–9110) and (2) the average of the hourly rates for a family medicine practitioner (29–1062) and a general internist (29–1063).

Estimated Annual Costs to the Federal
Government
Exhibit 3 shows the estimated total
and annualized cost to the Federal
Government for conducting this

research. These estimates include the
costs associated with the project such as
the preparation of survey administration
procedures, labor costs, administrative
expenses, costs associated with copying,
postage, and telephone expenses, data

management and analysis, and
preparation of final reports. The
annualized and total costs are identical
since the data collection period will last
for one year. The total cost is estimated
to be $436,524.

EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST

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Cost component

Total cost

Annualized
cost

Project Development ...............................................................................................................................................
Data Collection Activities .........................................................................................................................................
Data Processing and Analysis .................................................................................................................................
Publication of Results ..............................................................................................................................................
Project Management ................................................................................................................................................
Overhead .................................................................................................................................................................

$72,364
48,904
73,937
21,890
75,733
143,696

$72,364
48,904
73 937
21,890
75,733
143,696

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

436,524

436,524

Request for Comments
In accordance with the Paperwork
Reduction Act, comments on AHRQs

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information collection are requested
with regard to any of the following:
(a) Whether the proposed collection of

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information is necessary for the proper
performance of AHRQ healthcare
research and healthcare information

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Federal Register / Vol. 76, No. 58 / Friday, March 25, 2011 / Notices
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: March 15, 2011.
Carolyn M. Clancy,
Director.
[FR Doc. 2011–6857 Filed 3–24–11; 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
Agency for Healthcare Research
and Quality, HHS.
ACTION: Notice.
AGENCY:

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: ‘‘Using
Nursing Home Antibiograms to Improve
Antibiotic Prescribing and Delivery.’’ In
accordance with the Paperwork
Reduction Act, 44 U.S.C. 3501–3521,
AHRQ invites the public to comment on
this proposed information collection.
DATES: Comments on this notice must be
received by May 24, 2011.
ADDRESSES: Written comments should
be submitted to: Doris Lefkowitz,
Reports Clearance Officer, AHRQ, by
e-mail at
[email protected].
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

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SUMMARY:

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e-mail at
[email protected].
SUPPLEMENTARY INFORMATION:
Proposed Project
Using Nursing Home Antibiograms To
Improve Antibiotic Prescribing and
Delivery
Overuse and inappropriate use of
antibiotics, particularly broad-spectrum
antibiotics, is recognized as a serious
problem in nursing homes (NHs). The
adverse consequences of inappropriate
prescribing practices including drug
reactions/interactions, secondary
complications, and the emergence of
multi-drug resistant organisms, have
become more common. For example, in
one point-prevalence survey of 117 NH
residents, 43 percent were culturepositive for one or more antimicrobialresistant pathogens, including
methicillin-resistant staphylococcus
aureas (24 percent), extended-spectrum
+-lactamase-producing klebsiella
pneumoniae (18 percent) or Escherichia
coli (15 percent), and vancomycinresistant enterococci. Inappropriate
overprescribing and overuse of broadspectrum antibiotics, when narrower
spectrum drugs would suffice, are
believed to be important contributors to
this problem.
Physicians typically begin antibiotics
for suspected infections in NH residents
without waiting for bacteriology
laboratory culture results. If there is a
clinical failure (e.g., patient does not
improve), the physician may request a
bacteriology laboratory test, but will
often try a second antibiotic without
waiting for culture confirmation. If a NH
resident is deteriorating, many NHs do
not try a second antibiotic but will
instead transfer the patient to a hospital
emergency department (ED). In the ED,
physicians must make quick decisions
about whether to continue the first
antibiotic prescribed in the NH or start
another, again often without culture
results.
NH patients are transferred to EDs for
all sorts of medical reasons, including
but not limited to infections. When NH
patients arrive at an ED, physicians may
identify a urinary tract, respiratory, or
other infection that was not the primary
reason for the ED visit. Thus, patients
may not leave the NH with a suspected
bacterial infection or taking any
antibiotics, but an infection is suspected
in the ED and the first antibiotic is
prescribed there.
As a result of the above complexities,
NHs are increasingly recognized as
reservoirs of antibiotic-resistant
bacteria. Antibiograms aggregate
information for an entire institution

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over a period of several months or a
year. They display the organisms
present in clinical specimens sent for
laboratory testing, and the susceptibility
of each organisms to an array of
antibiotics. Antibiograms are routinely
prepared by hospital laboratories but are
not routine in the NH setting. The
culmination of this project will be a NH
Antibiogram toolkit so that NHs can
create facility-specific antibiograms that
are cost-effective and helpful to
physicians who must make antibiotic
prescription decisions without
bacteriology laboratory test results, for
patients in NHs, and for patients who
are transferred from the NH to the ED.
Outcomes of interest for antibiograms
include reduced reliance on broadspectrum antibiotics as initial therapy,
and fewer clinical failures of antibiotics
that are first prescribed. The
development of a toolkit will be the first
step in this process; future studies are
required to test the toolkit and,
subsequently, the effectiveness of NH
antibiograms.
The objectives of the study are to:
1. Develop a standardized method for
determining antibiotic susceptibility
patterns and developing NH-specific
antibiograms;
2. Extract preliminary data from NH
facilities of various sizes and types to
guide the development of the draft
toolkit; and
3. Develop a draft toolkit to guide a
wide variety of sizes and types of NHs
in developing and sharing antibiogram
information with prescribing providers
(i.e., physicians and physician
extenders) and EDs.
Three NHs and one ED will
participate in this study, which will be
conducted in two phases. The first
phase will include one small NH and
one ED and is intended to test the data
collection instruments and to draft the
initial toolkit, including the creation of
a NH specific antibiogram. The second
phase will expand the study by adding
two larger NHs, while retaining the
same NH and ED as in the first phase
and is intended to further test the data
collection instruments and refine the
draft toolkit. Each phase will use the
same methods and data collections.
This study is being conducted by the
Agency for Healthcare Research and
Quality through its contractors, Abt
Associates and the Brigham and
Women’s Hospital ED, pursuant to the
Agency for Healthcare Research and
Quality’s statutory authority to conduct
and support research on healthcare and
on systems for the delivery of such care,
including activities with respect to the
quality, effectiveness, efficiency,
appropriateness and value of healthcare

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