Measure Dx: A Resource To Identify, Analyze, and Learn From DiagnosticSafety Events

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 8 Appendix H: ECHO Call Protocol	Form and Instruction	New	Available
Form 8 Appendix H: ECHO Call Protocol	Form and Instruction	New	Repair queued
Form 7 Appendix G: Case Review Summary Form	Form and Instruction	New	Available
Form 7 Appendix G: Case Review Summary Form	Form and Instruction	New	Repair queued
Form 6 Appendix F: Team Questionnaire	Form and Instruction	New	Available
Form 6 Appendix F: Team Questionnaire	Form and Instruction	New	Repair queued
Form 5 Appendix E: Post-test Evaluation Interview Protocol	Form and Instruction	New	Available
Form 5 Appendix E: Post-test Evaluation Interview Protocol	Form and Instruction	New	Repair queued
Form 4 Appendix D: Pre-Test Interview Protocol	Form and Instruction	New	Repair queued
Form 4 Appendix D: Pre-Test Interview Protocol	Form and Instruction	New	Available
Form 3 Appendix C –Safer Dx Checklist	Form and Instruction	New	Available
Form 3 Appendix C –Safer Dx Checklist	Form and Instruction	New	Repair queued
Form 2 Appendix B: Organizational Self-Assessment	Form and Instruction	New	Available
Form 2 Appendix B: Organizational Self-Assessment	Form and Instruction	New	Repair queued
Form 1 Appendix A – Organizational Characteristics Survey	Form and Instruction	New	Available
Form 1 Appendix A: Organizational Characteristics Survey	Form and Instruction	New	Repair queued
0935-newStatement A_Dx_Measurement Resource Full Eval_final_v2 hhs.docx	Supporting Statement A	Uploaded 2022-08-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
255660	Appendix H: ECHO Call Protocol	Form and Instruction	New	Appendix H: ECHO Call Protocol
255660	Appendix H: ECHO Call Protocol	Form and Instruction	New
255659	Appendix G: Case Review Summary Form	Form and Instruction	New	Appendix G: Case Review Summary Form
255659	Appendix G: Case Review Summary Form	Form and Instruction	New
255658	Appendix F: Team Questionnaire	Form and Instruction	New	Appendix F: Team Questionnaire
255658	Appendix F: Team Questionnaire	Form and Instruction	New
255657	Appendix E: Post-test Evaluation Interview Protocol	Form and Instruction	New	Appendix E: Post-test Evaluation Interview Protocol
255657	Appendix E: Post-test Evaluation Interview Protocol	Form and Instruction	New
255656	Appendix D: Pre-Test Interview Protocol	Form and Instruction	New	Appendix D: Pre-Test Interview Protocol
255656	Appendix D: Pre-Test Interview Protocol	Form and Instruction	New
255655	Appendix C –Safer Dx Checklist	Form and Instruction	New	Appendix C –Safer Dx Checklist
255655	Appendix C –Safer Dx Checklist	Form and Instruction	New
255654	Appendix B: Organizational Self-Assessment	Form and Instruction	New	Appendix B: Organizational Self-Assessment
255654	Appendix B: Organizational Self-Assessment	Form and Instruction	New
255629	Appendix A: Organizational Characteristics Survey	Form and Instruction	New	Appendix A – Organizational Characteristics Survey
255629	Appendix A: Organizational Characteristics Survey	Form and Instruction	New

ICR Details

OMB Control No: 0935-0263	ICR Reference No: 202208-0935-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Measure Dx: A Resource To Identify, Analyze, and Learn From DiagnosticSafety Events
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/04/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/31/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2025	18 Months From Approved
Responses	180	0	0
Time Burden (Hours)	140	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Measure Dx resource (the Resource) is a modular toolkit that provides clinicians, quality and safety personnel, and healthcare organization leaders with guidance for implementing diagnostic safety measurement strategies for the purposes of learning and improvement. The Resource was developed and pilot tested (Fast Track OMB control number: 0935-0179) during the base year of an AHRQ contract awarded to the MedStar Health Research Institute and provides pragmatic recommendations for implementing measurement strategies that were identified in the AHRQ Issue Brief titled Operational Measurement of Diagnostic Safety: State of the Science. In particular, the Resource focuses on four broad measurement strategies that were assessed to be approaching readiness for implementation in operational settings. AHRQ is requesting full OMB approval to conduct a formal evaluation of the Resource. AHRQ would like to further develop this resource, expanding on the initial pilot test which qualitatively examined feasibility of implementing the resource, general receptivity, and feedback for improvement. This information collection has the following goal: 1. To evaluate the Resource in order to stimulate measurement activities for learning and improvement and quantitatively and qualitatively examine: a. Feasibility of implementing the Resource with limited to no technical assistance; b. User experience and satisfaction with the Resource; c. Impact of the Resource on diagnostic safety policies or activities; d. Yield of newly detected diagnostic safety events and associated learning resulting from use of the Resource; e. Intent to sustain use of the Resource and continue with the diagnostic safety process following evaluation efforts.

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

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:
	87 FR 36128	06/15/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 52778	08/29/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Appendix A: Organizational Characteristics Survey	1	Appendix A – Organizational Characteristics Survey
Appendix B: Organizational Self-Assessment	2	Appendix B: Organizational Self-Assessment
Appendix C –Safer Dx Checklist	3	Appendix C –Safer Dx Checklist
Appendix D: Pre-Test Interview Protocol	4	Appendix D: Pre-Test Interview Protocol
Appendix E: Post-test Evaluation Interview Protocol	5	Appendix E: Post-test Evaluation Interview Protocol
Appendix F: Team Questionnaire	6	Appendix F: Team Questionnaire
Appendix G: Case Review Summary Form	7	Appendix G: Case Review Summary Form
Appendix H: ECHO Call Protocol	8	Appendix H: ECHO Call Protocol

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ICR Summary of Burden

table that charts list 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	180	0	0	180	0	0
Annual Time Burden (Hours)	140	0	0	140	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: No

Burden Reduction Due to:

Short Statement: This is a new information collection, thus no changes in hour burden is expected or reported here.

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Annual Cost to Federal Government: $205,738

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? No

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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: 08/31/2022

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