Form 1 TeamSTEPPS in Primary Care Post-Training Survey

Is these acceptable explanations for Section 4 of SSA?

4. Efforts to Identify Duplication

AHRQ is aware of three concurrent evaluations of the TeamSTEPPS program, each requiring an OMB clearance package. Each is evaluating a different TeamSTEPPS training program and will collect data from distinct populations of individuals who participate in training. Each evaluation is described below.

1. Assessing the Impact of the National Implementation of TeamSTEPPS Master Training Program. . This effort provides in-person training to participants using the TeamSTEPPS core curriculum. AHRQ proposes to repeat an earlier survey of program participants and has submitted its prior OMB clearance package # 0935-0170for renewal.

2. TeamSTEPPS Online Master Training Course. This effort provides online training to participants using a newly developed online version of the TeamSTEPPS core curriculum. AHRQ proposes to conduct a formative evaluation of this web-based version of TeamSTEPPS training.

Implementation of TeamSTEPPS in Primary Care Settings. This effort (described in this OMB submission) provides training to primary care practice facilitators who then implement TeamSTEPPS in primary care practices. AHRQ proposes to conduct an evaluation of the primary care practice facilitator training.

10. Assurance of Confidentiality

Individuals will be assured of the confidentiality of their replies under Section 944(c) of the Public Health Service Act.  42 U.S.C. 299c-3(c).  That law requires that information collected for research conducted or supported by AHRQ that identifies individuals or establishments be used only for the purpose for which it was supplied.

Information that can directly identify the respondent, such as name and/or social security number will not be collected. Only basic biographical information will be collected for the purpose of describing the respondents. Participation will be voluntary and participants will be informed that their responses will be confidential. A statement of confidentiality will appear on the online survey and contain the following statement:

“The confidentiality of your responses are protected by Sections 944(c) and 308(d) of the Public Health Service Act [42 U.S.C. 299c-3(c) and 42 U.S.C. 242m(d)]. Information that could identify you will not be disclosed unless you have consented to that disclosure.”

IMPAQ International will collect all information and response data will be stored on secure serves. Files will be password protected. Only members of the IMPAQ project team will have access to the data. Only aggregated data will be reported to AHRQ.

Exhibit 3.  Estimated Total and Annualized Cost

Cost Component	Total Cost	Annualized Cost
Project Development	$41,188	20,594
Data Collection Activities	5,754	2,877
Data Processing and Analysis	14,294	7,147
Publication of Results	7,154	3,577
Project Management	14,712	7,356
Overhead	41,544	20,772
Total	124,646	62,323

Attachment A -- TeamSTEPPS Primary Care Post-training Survey