Nursing Home Survey on Patient Safety Culture Comparative Database

Forms and Documents

Document Name	Status
Form Form #1 Eligibility/Registration Form Form and Instruction	New
Form Form #4 Data Submission Form and Instruction	Modified
Form Form #3 Nursing Home Site Information Form Form	Modified
Form Form #2 Data Use Agreement Form and Instruction	Modified
Form Form #1 Eligibility/Registration Forms Form	Removed
Attachment G - Example Screenshots of NH SOPS Data Submission Web Site Information Collection.docx Supplementary Document	2015-07-15
Attachment E - Nursing Home Data File Specifications.pdf Supplementary Document	2015-07-15
201507-0935-001_Supporting Statement Part B -- NHSOPS Comp DB_12-4-14_2015-08-05 Comments_8-7-15 Westat response.doc Supporting Statement B	2015-09-01
Attachment F - SOPS Databases TEP list.doc Supplementary Document	2015-07-15
201507-0935-001_Supporting Statement Part A -- NHSOPS Comp 08312015.docx Supporting Statement A	2015-08-31

IC Document Collections

IC ID	Document Title	Status
217465	Eligibility/Registration Form Form and Instruction	New
201035	Data Submission Form and Instruction	Modified
201034	Nursing Home Site Information Form Form	Modified
201033	Data Use Agreement Form and Instruction	Modified
201032	Eligibility/Registration Forms Form	Removed

ICR Details

OMB Control No: 0935-0195	ICR Reference No: 201507-0935-001
Status: Historical Active	Previous ICR Reference No: 201202-0935-003
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Nursing Home Survey on Patient Safety Culture Comparative Database
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/30/2015
	Date Received in OIRA: 07/16/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2018	36 Months From Approved	06/30/2015
Responses	2,400	0	85
Time Burden (Hours)	455	0	4
Cost Burden (Dollars)	0	0	0

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Abstract: In 1999, the Institute of Medicine called for health care organizations to develop a "culture of safety" such that their workforce and processes focus on improving the reliability and safety of care for patients (IOM, 1999; To Err is Human: Building a Safer Health System). To respond to the need for tools to assess patient safety culture in health care, AHRQ developed and pilot tested the Nursing Home Survey on Patient Safety Culture with OMB approval (OMB NO. 0935-0132; Approved July 5, 2007). The survey is designed to enable nursing homes to assess provider and staff opinions about patient safety issues, medical error, and error reporting and includes 42 items that measure 12 dimensions of patient safety culture. AHRQ made the survey publicly available along with a Survey User's Guide and other toolkit materials in November 2008 on the AHRQ Web site (located at http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/nursing-home/index.html). The AHRQ Nursing Home SOPS Comparative Database consists of data from the AHRQ Nursing Home Survey on Patient Safety Culture. Nursing homes in the U.S. are asked to voluntarily submit data from the survey to AHRQ through its contractor, Westat. The Nursing Home SOPS database (OMB NO. 0935-0195, last approved on June 12, 2012) was developed by AHRQ in 2011 in response to requests from nursing homes interested in knowing how their patient safety culture survey results compare to those of other nursing homes in their efforts to improve patient safety. Rationale for the information collection. The Nursing Home SOPS and the Comparative Database support AHRQ's goals of promoting improvements in the quality and safety of health care in nursing home settings. The survey, toolkit materials, and comparative database results are all made publicly available on AHRQ's Web site. Technical assistance is provided by AHRQ through its contractor at no charge to nursing homes, to facilitate the use of these materials for nursing home patient safety and quality improvement. The goal of this project is to renew the Nursing Home SOPS Comparative Database. This database will: 1) Allow nursing homes to compare their patient safety culture survey results with those of other nursing homes, 2) Provide data to nursing homes to facilitate internal assessment and learning in the patient safety improvement process, and 3) Provide supplemental information to help nursing homes identify their strengths and areas with potential for improvement in patient safety culture.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 15229	03/23/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 38205	07/02/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Eligibility/Registration Form	Form #1	Eligibility/Registration Form
Data Use Agreement	Form #2	Data Use Agreement
Nursing Home Site Information Form	Form #3	Nursing Home Site Information Form
Data Submission	Form #4	NH Welcome and Login Pages
Eligibility/Registration Forms	Form #1	Eligibility/Registration Forms

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,400	85	0	2,315	0	0
Annual Time Burden (Hours)	455	4	0	451	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The estimated hour burden for data file submission decreased from 5.5 hours in the previous information collection request (ICR) to 1 hour in this ICR. This decrease is due to efficiencies and improvements made in the data submission system. Even though the number of potential respondents increased since the last ICR, the total burden hours have decreased from 511 to 455, a decrease of 56 hours.

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Annual Cost to Federal Government: $180,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/16/2015

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