PCMH OMB Supporting Statement Part B Final 5.13.2015

Military Health Service (MHS) Patient Centered Medical Home (PCMH) Staff Satisfaction Survey

SUPPORTING STATEMENT – PART B

B.  COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS

1.  Description of the Activity

This is a multi-year study, with emphasis on social behavioral research derived from exploratory data collection via a Staff Satisfaction Survey. The target population of this study consists of all contractor personnel assigned to direct care military treatment facilities (MTFs). The previous iteration of this survey included active duty military personnel and federal employees, but did not include contractors. There are approximately 3,105 contractor personnel. The survey is a census of contractor personnel assigned to direct care military treatment facilities (MTFs), rather than as a systematic statistical sample. The population and the findings will be generalizable to the contractor personnel assigned to direct care military treatment facilities (MTFs). Eligible staff include: physicians, nurse practitioners, physician assistants, registered nurses, licensed practical nurses, corpsmen, and administrative staff. Based on response rates from civilian and active-duty military staff over the past two years, we conservatively anticipate a 45% response rate (approximately 1,397 respondents out of 3,105 potential contractor participants). The historical survey participation rates for each of the four military service components are provided in Table 1 below.

Table 1 – PCMH Staff Satisfaction Survey Population and Response Rates 2011 - 2012

	Total Population	2011 Total Completed Surveys	2011 Response Rate (%)	2012 Total Completed Surveys	2012 Response Rate (%)	2012 Total Completed Surveys	2012 Response Rate (%)
Army	5,486	2,362	43%	1,727	31%	2,416	44%
Navy	3,745	1,052	27%	1,022	27%	1,944	52%
Air Force	3,719	995	27%	623	17%	1,419	38%
JTF CAPMED	147	-	-	45	31%	86	59%
Total	13,097	4,409	34%	3,417	26%	5,865	45%

2.  Procedures for the Collection of Information

Describe any of the following if they are used in the collection of information:

a.  Statistical methodologies for stratification and sample selection;

b.  Estimation procedures;

c.  Degree of accuracy needed for the Purpose discussed in the justification;

d.  Unusual problems requiring specialized sampling procedures; and

e.  Use of periodic or cyclical data collections to reduce respondent burden.

As noted in the response to item 1, Needs and Uses in Supporting Statement Part A, the survey will be conducted as a census of contractor personnel assigned to direct care military treatment facilities (MTFs), rather than as a systematic statistical sample. TMA will evaluate non-response rates by Service Branch of assignment for the contractor population and if there is substantial difference across Services, TMA will calculate post-stratification weights to mitigate any potential bias resulting from over-, or under-representation of Services in the respondent population. In addition, as this survey will be conducted as a census intended to solely describe the population, we do not calculate confidence and precision estimates since findings will be generalizable to the contractor personnel assigned to direct care military treatment facilities (MTFs) who participate in the survey.

The letter will inform PCMH personnel that a web-based survey will be conducted and communicate

• the reason for the information collection,

• the information collection method,

• the burden estimate,

• the nature of the response (voluntary),

• the nature and extent of privacy to the extent permitted by law, and

• the use of the OMB control number.

3.  Maximization of Response Rates, Non-response, and Reliability

Response and retention rates are of utmost importance to PCMH researchers. Much effort has been focused on investigating of effects of survey length, frequency of email reminders, accuracy of email contact information, and periodicity of conducting the survey on survey response rates and non-response.

As a result of this investigation, the PCMC researchers have taken steps to increase response rates and reduce non-response including reducing the overall length of the PCMH Staff Satisfaction survey by more than 80%, eliminating 78 items from the questionnaire for more targeted and streamlined data gathering. Further changes to the survey content focused on optimizing streamlined survey design incorporating conditional ‘skip logic’ programming to further reduce survey burden and encourage greater participation. All survey responses will be collected via an online web-based survey interface. The PCMH researchers will utilize military service points of contact at each clinic to distribute an anonymous survey to all military, federal employee staff, and contractors at the study sites. Each digitally signed email will include a url to the web-based survey and a text explanation of the study to help encourage staff to participate. Invitations and email contact are designed specifically for service branch. TMA will evaluate non-response rates by Service Branch of assignment for the contractor population , and if there is substantial difference across Services, TMA will calculate post-stratification weights to mitigate any potential bias resulting from over-, or under-representation of Services in the respondent population.

On an annual basis, the PCMH researchers will conduct a non-response bias analysis for the PCMH facilities to determine the representativeness of the survey results . Using the administrative data on Federal, Military, and contractor populations, the researchers will conduct a non-response bias analysis comparing differences on key characteristics such as service branch affiliation, staff type, and team role between responders and non-responders. The researchers will identify internal and external validity checks for sources of bias such as publicly available information on PCMH staffing and facilities. Additionally, the team may employ an analysis utilizing base weights for the survey stage to compare the proportion distribution of characteristics of respondents and non-respondents, comparisons of respondents to known population characteristics from external sources, and other statistically relevant methods.

4.  Tests of Procedures

The data collection instrument will be pre-tested prior to the full launch of the survey, to refine the instrument and improve the respondents’ ability to provide the requested information. The PCMH investigators will conduct the pre-testing online with up to nine PCMH stakeholders. A representative from the PCMH Advisory board will also participate in the pre-testing. The draft questionnaire will be tested to ensure that respondents can properly understand the questions and that the response options are comprehensive. The testing will validate question wording, response options, and total administration time fielding to the survey’s target populations. Pre-testing has not yet been conducted.

5.  Statistical Consultation and Information Analysis

a.  Provide names and telephone number of individual(s) consulted on statistical aspects of the design.

Kimberley Marshall, PhD

Senior Health Care Research Analyst

TRICARE Management Activity

Defense Health Cost Assessment and Program Evaluation (DHCAPE)

TRICARE Management Activity

[email protected]

b.  Provide name and organization of person(s) who will actually collect and analyze the collected information.

Michael Knight

Deloitte Consulting, LLC.

[email protected]

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