Request for Approval (0920-1005)

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1005)

TITLE OF INFORMATION COLLECTION: Stopping Elderly Accidents, Deaths and Injuries (STEADI) in a Hospital Discharge Setting

PURPOSE:

Each year, one in four adults falls, resulting in an estimated $31billion in Medicare costs. To address this public health problem, the CDC developed the STEADI (Stopping Elderly Accidents, Deaths and Injuries) initiative. Adapted from American and British Geriatric Societies’ clinical practice guidelines, STEADI is a suite of materials developed by CDC to help primary care providers identify and manage fall risks among their older adult patients. STEADI is a multifaceted toolkit created by the Division of Unintentional Injury Prevention (DUIP) to assist clinicians in reducing falls in adults 65 and over (older adults). The toolkit includes information on how to conduct fall risk screening and risk assessments, how to review medications for their potential fall risk, and guidance on evidence-based interventions.

STEADI material also have potential to be used to screen and assess older adults in the hospital discharge setting for falls risk, and to intervene with the older adult at a point where he/she may be at more risk for a fall due to deconditioning from being in the hospital. Hospitals have an interest in preventing falls in recently discharged patients, as Medicare no longer reimburses hospitals when certain patients are readmitted within 30-days of their initial discharge. Implementing fall prevention measures as part of the discharge process provides an opportunity to intervene immediately, and to arrange primary care follow up for patients at risk of falling.

The purpose of this request is to gather timely customer satisfaction on the feasibility and acceptability of implementing components of STEADI into the hospital discharge process and to identify any areas for improvement of STEADI materials. CDC will use findings from the data collected to refine the service provided through STEADI. Feedback gathered will help ensure NCIPC is providing efficient and effective service delivery.

Information gathered will be used only internally to improve the service of STEADI. Information is not intended for release outside of the agency. Information gathered will not be used for the purpose of substantially informing influential policy decisions. Without these types of feedback, CDC will not have timely information about what strategies are most likely to be effective for disseminating the STEADI material in a hospital discharge setting, and acceptability by the healthcare providers involved.

DESCRIPTION OF RESPONDENTS:

Participation is voluntary. Respondents will be clinical staff (physician, nurse, physical therapist) at the University of California San Francisco Medical Center where components of STEADI have been implemented. A total of 900 individuals will be invited to participate in the study.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [X ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [] Other:

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name:_____Karen Angel ________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [] Yes [ X] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [X] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ X ] No

During data collection, the contractor (Intellix) will collect names of those respondents who wish to participate in order to correspond. At no time does CDC have access to, or will receive, potentially identifiable information. At no time is this information linked or linkable to surveyed information. The CDC Office of the Chief Information Officer has determined that the Privacy Act does not apply (Att. A)

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [] Yes [ X ] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time (Hours)	Burden
Healthcare Providers – Invitation Correspondence (Att. B)	900	2/60	30
Healthcare Providers – Falls Prevention Participant Survey (Att. C)	632	7/60	74
Totals			104

FEDERAL COST: The estimated annual cost to the Federal government is $6,649

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [X ] Yes [] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

Respondents will be clinical staff (physician, nurse, physical therapist) at the University of California San Francisco Medical Center where components of STEADI have been implemented. A total of 900 individuals will be invited to participate in the study. The population of interest for the study is clinical staff (i.e., physicians, nurses and physical therapists) involved in delivering health care to older adults who are at an increased risk for falls, defined as adults 65 years and older who are hospitalized in an inpatient environment for 48 hours or longer but are within 18 hours of hospital discharge. These health care providers work in the units where the STEADI initiative was incorporated into the hospital discharge setting and possess the experience and expertise necessary to provide the information being collected. There will be no sampling; all 900 members of the respondent population will be surveyed.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[] Telephone

[] In-person

[ ] Mail

[ X ] Other, Explain - Email

2. Will interviewers or facilitators be used? [] Yes [ X] No

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