Cover Letter

SUBMISSION OF INFORMATION COLLECTION UNDER THE

Request for Approval under AHRQ’s Generic Clearance “Questionnaire and Data Collection Testing, Evaluation, and Research for the AHRQ” (OMB Control Number: 0935-0124)

DATE OF REQUEST: December 3, 2015

SUB AGENCY (I/C): HHS/AHRQ

TITLE: Environmental Scan for Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families

GENERIC CLEARANCE UNDER OMB#: 0935-0179 EXP. DATE: 07/31/2018

ABSTRACT:

Patient and family engagement (PFE) is an evolving concept in healthcare transformation and a number of frameworks have been developed that call for PFE as a means for achieving patient-centered care. The evidence base suggests significant advancement in hospital based patient and family involvement in patient safety. We are building a robust, scalable, and influential guide for patients and families. The initial step to our approach is an environmental scan. The purpose of this request is to conduct a series of voluntary key informant interviews as part of the environmental scan- for the Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families (Guide). The environmental scan is developmental work serving as the preliminary activity for a project that we will submit to OMB at a later date. We will conduct this environmental scan to analyze a wide range of research and non-research material to provide greater conceptual clarity about the field to develop the Guide. As part of this scan, we will conduct a series of interviews to help us with the following for the larger project to be submitted to OMB at a future date.

TOTAL ANNUAL BURDEN APPROVED: 3,383 Hours Per year

BURDEN USED TO DATE: 0 hours.

BURDEN THIS REQUEST: 43 hours.

FEDERAL COST: The estimated annual cost to the Federal government is $600_____.

IS RACE AND ETHNICITY DATA COLLECTED AS REQUIRED?

______YES ______ NO _____x_ N/A

OBLIGATION TO RESPOND:

___x___ VOLUNTARY

______ REQUIRED TO OBTAIN OR RETAIN BENEFITS

______ MANDATORY

HOW WILL THIS SURVEY BE OFFERED?

__x___ WEB SITE

__x___ TELEPHONE INTERVIEW

__x___ MAIL RESPONSE [email]

__s___ IN PERSON INTERVIEW

_____ OTHER: ___________________________________

CONTACT INFORMATION:

NAME: _Nancy Wilson______________________________

TELEPHONE NUMBER: 301.427.1652________________

EMAIL ADDRESS: [email protected]________________