Emergency SSB Cardiac Arrest in CT

Undetermined cause of cardiac arrest during hemodialysis – Connecticut 2015-2016

Request for OMB Approval of a New Emergency Information Collection

January 26, 2016

Supporting Statement B

Table of Contents

1. Respondent Universe and Sampling Methods 2

2. Procedures for the Collection of Information 2

3. Methods to Maximize Response Rates and Deal with No Response 2

4. Tests of Procedures or Methods to be Undertaken 2

5. Individuals Consulted on Statistical Aspects and Individuals Collecting and/or Analyzing Data 2

Contact:

Lee Samuel

National Center for Emerging and Zoonotic Infectious Diseases

Centers for Disease Control and Prevention

1600 Clifton Road, N.E.

Atlanta, Georgia 30333

Phone: (404) 718-1616

Email: [email protected]

No statistical methods are used in this data collection.

1. Respondent Universe and Sampling Methods

Respondents include: (1) case patients who suffered cardiac arrests, (2) patients who were receiving dialysis treatment at the same clinics at the times when the case patients suffered cardiac arrests; (3) healthcare workers at outpatient hemodialysis clinics, including clinic managers, nurses, dialysis technicians, physicians, infection preventionists, and other staff.

Patients who experienced cardiac arrests and patients who were receiving dialysis treatment at the same clinics at the times when the case patients had cardiac arrests will be selected for this activity. The patient list at each clinic will be used to select eligible patients.

All clinic staff who presented at the clinics during the events will be selected. Nationwide case finding will be implemented (through Epi-X or professional list serve). Any additional cases identified through case finding will be included in the activity.

2. Procedures for the Collection of Information

Medical charts of case patients who suffered cardiac arrest will be reviewed and abstracted onto a standardized form.

Case patients who survived, other patients at clinics during time of events, and healthcare staff at clinics will be interviewed using standardized questionnaires.

For any additional cases identified through case finding, information of those cases provided by healthcare workers who report them will be collected onto a data collection form. Depending on the nature of each case, CDC may reach out to relevant healthcare facilities or healthcare staff for additional information (using chart abstraction form).

3. Methods to Maximize Response Rates and Deal with No Response

We expect to abstract all charts of case-patients. Response to the interview is voluntary. Given the severity of the events, CDC will work with local health departments and facility staff to achieve highest response rate possible. We expect to have 100% response rate from healthcare staff and 90% response rate from patients. The information requested has been kept to the absolute minimum in order to minimize the public burden.

4. Tests of Procedures or Methods to be Undertaken

We do not perform a test of the abstraction forms or interview questions. The Division of Healthcare Quality Promotion has extensive experience carrying out investigations of this type (i.e., investigations of healthcare-associated infections or healthcare-related adverse events in dialysis facilities).

5. Individuals Consulted on Statistical Aspects and Individuals Collecting and/or Analyzing Data

There are no statistical aspects of this information and therefore no individuals were consulted.