Fast-track Template Practice Transformation

Request for Approval under the Generic Clearance for the Collection of Routine Customer Feedback (OMB Control Number: 0925-0648)

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TITLE OF INFORMATION COLLECTION: Qualitative Service Delivery Feedback for National Diabetes Education Program (NDEP) through an Online Survey among Health Professionals

PURPOSE: The National Diabetes Education Program (NDEP), a partnership of the National Institutes of Health and the Centers for Disease Control and Prevention, seeks to collect service delivery feedback from health professional users of “Practice Transformation for Physicians and Health Care Teams.”

NDEP seeks to collect customer satisfaction feedback from “Practice Transformation” current users through a 10-minute online survey. “Practice Transformation for Physicians and Health Care Teams” is designed for health care professionals and administrators who want to change systems of health care delivery around diabetes. This free online resource provides models, links, and tools to help physicians and health care teams initiate and maintain quality improvements in their health care practice. Content featured on this site (http://ndep.nih.gov/hcp-businesses-and-schools/practice-transformation/) is based on current, peer-reviewed literature and evidence-based clinical practice recommendations. NDEP intends to collect user feedback through a survey link on the “Practice Transformation” web page. Users can voluntarily take the survey to provide feedback on how they are currently using resources, their level of satisfaction with resources, and what they would find most useful in future resources. Feedback will be used to determine the extent to which this website is a useful tool for health care professionals and to inform NDEP’s future design, collection of resources, or development of new content, as necessary. No personally identifiable information will be collected in this survey.

DESCRIPTION OF RESPONDENTS: Respondents will include the following:

Customer satisfaction survey for “Practice Transformation”: Respondents will include users of the Practice Transformation section of the NDEP web site, which is intended for health professionals. On average, 4,570 people visit the Practice Transformation section of the site each month (based on page views from September 2013 through February 2014, gathered through Google Analytics). We anticipate 7% of visitors will take the survey, based on response rates for similar voluntary web surveys that do not provide an incentive.¹ Therefore, we anticipate 300-320 responses within the first months of fielding, with a diminishing response rate after that. To achieve a desired number of 1,000 responses, we anticipate keeping the survey link on the web page for up to six months.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [x] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Groups [ ] Other:

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name:________________________________________________

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [ x ] No

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No

No personally identifiable information will be collected in the web survey.

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [ x ] No

No incentive will be offered for the web survey.

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden*
Individuals for online survey: Health professional users of “Practice Transformation for Physicians and Health Care Teams” online resource	1,000	10 minutes	167 hours

*Burden has been rounded to the nearest whole hour increment.

FEDERAL COST: The estimated total cost to the Federal government is $9,000.

The costs include research design, developing instruments, development of the Office of Management and Budget information collection package, data collection and management, data analyses, and reporting and presenting the findings to the NDEP senior management after the analyses are completed.

Estimates of Costs to the Federal Government
Task	Estimated Cost
Planning and development (research design, developing instruments, development of the OMB ICR)	$3,000
Data analysis and reporting	$6,000
TOTAL	$9,000

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [x] Yes [ ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

The sample for the online survey will be a convenience sample of “Practice Transformation” users who voluntarily take the survey through the link on the web page.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[x] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [ x ] No

The online survey will be programmed in a survey tool and embedded as a link in the Practice Transformation web page of the NDEP web site. Data will be collected through the survey tool anonymously and aggregated through frequencies, cross tabulations and other descriptive statistics. The online survey will not involve the use of facilitators or moderators.

Please make sure that all instruments, instructions, and scripts are submitted with the request.

The following instrument is attached:

• Attachment 1: Survey questionnaire for professional users of “Practice Transformation”

1 Rand Corporation, “Literature Review of Web and E-Mail Surveys,” a chapter in Conducting Research Surveys via E-mail and the Web, 2002. http://www.rand.org/content/dam/rand/pubs/monograph_reports/MR1480/MR1480.ch3.pdf

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