Attachment H -- Federal Register Notice

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Federal Register / Vol. 77, No. 17 / Thursday, January 26, 2012 / Notices

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:
‘‘Assessing the Feasibility of
Disseminating Effective Health Center
Products through Mobile Phone
Applications.’’ 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 November 15th, 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 February 27, 2012.
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].
gov (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
email at [email protected].
SUPPLEMENTARY INFORMATION:
SUMMARY:

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Proposed Project
Assessing the Feasibility of
Disseminating Effective Health Center
Products Through Mobile Phone
Applications
The Agency for Healthcare Research
and Quality (AHRQ) requests that the
Office of Management and Budget
(OMB) approve, under the Paperwork
Reduction Act of 1995, this collection of
information from users of work products
and services initiated by the John M.
Eisenberg Clinical Decisions and
Communications Science Center
(Eisenberg Center).

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AHRQ is the lead agency charged
with supporting research designed to
improve the quality of healthcare,
reduce its cost, improve patient safety,
decrease medical errors, and broaden
access to essential services. AHRQ’s
Eisenberg Center’s mission is improving
communication of findings to a variety
of audiences (‘‘customers’’), including
consumers, clinicians, and health care
policy makers. The Eisenberg Center
compiles research results into useful
formats for customer stakeholders. The
Eisenberg Center also conducts
investigations into effective
communication of research findings in
order to improve the usability and rapid
incorporation of findings into medical
practice. The Eisenberg Center is one of
three components of AHRQ’s Effective
Health Care (EHC) Program. The
collections proposed under this
clearance include activities to assess the
feasibility of using specific media and
awareness-raising processes to
encourage consumers who are at risk for
selected health problems for which EHC
Program materials are available to
access information about such materials
using mobile phone technologies. The
project will specifically focus on
promoting awareness of eight consumer
guides developed through the EHC
Program. The guides are all published in
English and Spanish-language versions.
All of the guides are designed to help
decision makers, including clinicians
and health care consumers, use research
evidence to maximize the benefits of
health care, minimize harm, and
optimize the use of health care
resources.
The project will test the feasibility of
using mobile telephone technology for
the dissemination of EHC Program
materials to underserved health
consumer populations using: (a) Short
message services (SMS), usually referred
to as texting, that can be provided to
people with basic cell phone service
and texting support; and (b) mobile Web
access that provides access to the
Internet via a mobile interface.
Different methods and/or vehicles
will be used to promote awareness of
opportunities to obtain cell phone- or
smart phone-based information about
the availability of EHC Program
materials including: (1) Wall posters in
patient service areas of the three (3)
participating clinics; (2) flyers about the
products distributed in magazine racks
and through patient kiosks in some
areas of the clinics; (3) flyers/
announcements given to patients at
checkout from the clinic; and (4) health
fairs convened to address general health
issues, where the information can be
provided. Promotional materials will

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invite potential users to send a specific
text message with the keyword
associated with the relevant health
condition to the advertised number.
Subjects will receive a response text
with a brief message about the condition
and an invitation to either (a) request a
printed consumer guide or (b) access the
mobile Web site to view the guide.
This project has the following goals:
(1) Summarize marketing efforts in
terms of total numbers of posters, flyers,
and information sheets distributed
through specific venues (e.g., patient
waiting areas, patient check-out
processes) and numbers of individuals
contacted through health fairs and
related activities;
(2) Summarize the extent to which
persons in targeted patient populations
responded to marketing efforts;
(3) Assess patient satisfaction with: (a)
The means by which patients were
alerted as to the availability of EHC
Program materials; (b) the methods
patients used to request and access the
EHC Program materials; and (c) the
value and relevancy of the information
that they obtained;
(4) Characterize perceptions of
clinical care providers and clinical staff
persons in terms of: (a) The value of
efforts to promote patient awareness of
EHC Program materials using marketing
techniques described in this feasibility
project; and (b) the effect of these efforts
on workflow issues and related aspects
of clinic operations.
This study is being conducted by
AHRQ through its contractor, the
Eisenberg Center—Baylor College of
Medicine, pursuant to AHRQ’s statutory
authority to conduct and support
research, and disseminate information,
on healthcare and on systems for the
delivery of such care, including
activities with respect to both the
quality, effectiveness, efficiency,
appropriateness and value of healthcare
services and clinical practice. 42 U.S.C.
299a(a)(1) and (4).
Method of Collection
To achieve the goals of this project the
following data collections will be
implemented:
(1) Focus Groups with Clinicians. A
focus group will be conducted at each
of the three participating clinics during
regularly scheduled internal clinic
meetings, to determine how the
introduction of marketing materials and
related resources influenced, if at all,
delivery of care in the clinical settings.
Special emphasis will be placed on
determining if introduction of the
project materials changed the ways in
which patients interacted with
clinicians. It is expected that each focus

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Federal Register / Vol. 77, No. 17 / Thursday, January 26, 2012 / Notices
group will include no more than 10
clinical professionals (e.g., physicians,
physician assistants, nurses and nurse
practitioners, pharmacists).
(2) Focus Groups with Support Staff.
A focus group will be conducted with
support staff working in each of the
three participating clinics, during
regularly scheduled meetings, to
determine if the introduction of the
project materials altered clinic
workflows. It is expected that each focus
group will include no more than 12
support staff (e.g., receptionists, nursing
assistants, other personnel who interact
with patients).
(3) Patient Interviews. In-person
interviews conducted immediately after
the patient exits the clinic will be used
to determine if patients: (a) Saw and
understood the marketing materials
(e.g., posters and flyers) in clinic
settings; (b) were encouraged by the
marketing materials to text and request
information about their health issue(s);
(c) could identify specific reasons why
they did or did not text; and (d) have
suggestions about how marketing
materials might be changed so that they
would be more likely to encourage
patients like themselves to text.
(4) Feedback Questionnaire for
Patients Requesting Mailed Guides. All
persons that respond to the marketing
materials by requesting any of the eight
guides to be mailed to them will be
asked to complete a brief paper
questionnaire included with the guides.
The purpose of the questionnaire is to
assess the extent to which the guides
were easy to read and understand,
whether the guides provided the
information they sought, and any
suggestions for improving and
delivering the guides.
(5) Feedback Questionnaire for
Patients Visiting the Mobile Web Site.
All persons that access the guides via
the mobile Web site will be asked to
complete a brief online questionnaire.
Only subjects exposed to the promotion
materials will receive the address of the
mobile Web site during the text message
conversation, and therefore we expect
no other individuals to visit this site.

The purpose of the questionnaire is to
determine if the guides were useful, the
mobile Web site was easy to use,
whether they found the information
they needed and experienced any
difficulty in accessing the guides
through their cell phone.
(6) Usage Log Data. Data from
automated electronic log systems will be
collected from two sources: (1) Mobile
Commons, the contractor that manages
the cell phone-related message delivery
and cell phone-based communication;
and (2) the Eisenberg Center at Baylor
College of Medicine that manages the
EHC Web site visits. Usage log data
gathered from the cell phone service
contractor will include: (1) Counts of
text messages received from persons
requesting information about consumer
guides; (2) the distribution of message
counts across originating clinics tracked
through the use of distinctive call-in or
short code numbers assigned to each
clinic; and (3) the numbers and
originating clinic-specific distributions
of follow-up texts Because text
communications will be date and time
stamped, Eisenberg Center staff will be
able to calculate mean durations in time
from receipt of the initial messages and
follow-ups, which may be useful in
determining navigation patterns and
suggesting connectivity barriers. Usage
log data gathered from the mobile Web
site will allow for identification of: (1)
The number of visitors that originate
from a specific uniform record locator
(URL) associated with each clinic; (2)
the duration of visits to the EHC Web
site to gather desired information and
explore other resources available
through the Web site; (3) the number of
pages viewed by each visitor; and (4) the
number of downloads of the full report
associated with each guide, which will
also be made available. These data will
be obtained using automated systems
already in place, and no special effort
will be needed to generate these data;
this task is not included in the burden
estimates in Exhibit 1 below.
The Eisenberg Center will determine
the feasibility of this approach to

encouraging patients and anyone else
viewing the marketing materials to
access information that may be helpful
to them in understanding health care
choices and engaging more fully in their
own health care, and whether this
approach should be pursued further.
This information will be used to
determine the feasibility of: (a)
Mounting broader efforts to distribute
consumer guides, as well as other EHC
Program products, using mobile
technologies as tools to heighten
awareness of these resources by
potential users who rely on mobile
communication devices for information
access; and (b) initiating additional
studies to identify factors that encourage
or deter effective use of increasingly
pervasive communication modalities
(e.g., cell phones, smart phones) in
communicating with care providers and
others and to access information from
the Internet and health-related Web
sites.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated
annualized burden for the respondents’
time to participate in this research.
Focus groups will be conducted with
about 10 clinicians per each of the 3
participating clinics (30 total) and about
12 clinical support staff per clinic (36
total), and will last 45 minutes.
Interviews will be conducted with about
100 patients per clinic (300 total) upon
exit from the clinical visit, with each
interview lasting about 15 minutes. The
Feedback Questionnaire for the Mailed
Guides will be completed by
approximately 200 persons and will
take 10 minutes to complete and the
Feedback Questionnaire for the Mobile
site will be completed by about 200
persons and also requires 10 minutes to
complete. The total annual burden is
estimated to be 191 hours. Exhibit 2
shows the estimated annualized cost
burden associated with the respondent’s
time to participate in this research. The
total annual cost burden is estimated to
be $5,320.

EXHIBIT 1—ESTIMATED ANNUALIZED TOTAL BURDEN HOURS
Number of
respondents per
respondent

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Type of data
collection

Number of
responses

Hours per
response

Total
burden hours

Focus Groups with Clinicians ..........................................................
Focus Groups with Support Staff ....................................................
Patient Interviews ............................................................................
Feedback Questionnaire for Patients Requesting Mailed Guides ..
Feedback Questionnaire for Patients Visiting Mobile Web site ......

30
36
300
200
200

1
1
1
1
1

45/60
45/60
15/60
10/60
10/60

23
27
75
33
33

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

766

na

na

191

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Federal Register / Vol. 77, No. 17 / Thursday, January 26, 2012 / Notices
EXHIBIT 2—ESTIMATED ANNUALIZED TOTAL COST BURDEN
Type of data
collection

Number of
respondents

Average
hourly wage
rate *

Total
burden hours

Total
cost burden

Focus Groups with Clinicians ..........................................................
Focus Groups with Support Staff ....................................................
Patient Interviews ............................................................................
Feedback Questionnaire for Patients Requesting Mailed Guides ..
Feedback Questionnaire for Patients Visiting Mobile Web site ......

30
36
300
200
200

23
27
75
33
33

$83.59
14.31
21.35
21.35
21.35

$1,923
386
1,601
705
705

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

766

191

na

5,320

* Based upon the mean wages for clinicians (29–1062 family and general practitioners), clinical team members (31–9092 medical assistants)
and consumers (00–0000 all occupations), National Compensation Survey: Occupational wages in the United States May 2010, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’

Estimated Annual Costs to the Federal
Government
The maximum cost to the Federal
Government is estimated to be $203,531

annually. Exhibit 3 shows the total and
annualized cost by the major cost
components.

EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST
Cost component

Annualized cost

Project Development .......................................................................................................................................
Data Collection Activities .................................................................................................................................
Data Processing and Analysis .........................................................................................................................
Project Management ........................................................................................................................................
Overhead .........................................................................................................................................................

$146,175
85,425
65,375
47,588
62,500

$73,088
42,713
32,688
23,794
31,250

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

407,063

203,531

Request for Comments

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Total cost

In accordance with the Paperwork
Reduction Act, 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 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: January 17, 2012.
Carolyn M. Clancy,
Director.
[FR Doc. 2012–1402 Filed 1–25–12; 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: ‘‘Nursing
Home Survey on Patient Safety Culture
Comparative Database.’’ 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

SUMMARY:

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Register on November 2nd, 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 February 27, 2012.
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
email at [email protected].
SUPPLEMENTARY INFORMATION:
Proposed Project
Nursing Home Survey on Patient Safety
Culture Comparative Database
The Agency for Healthcare Research
and Quality (AHRQ) requests that the
Office of Management and Budget
(OMB) approve, under the Paperwork
Reduction Act of 1995, AHRQ’s

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