The AHRQ Safety Program for Telemedicine: Improving Antibiotic Use

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10 Attachment J: Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort	Form and Instruction	Removed	Available
Form 10 Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort	Form and Instruction	Removed	Repair queued
Form 6 Draft Interview Guide	Form and Instruction	Modified	Available
Form 6 Semi-Structured Qualitative Interviews (telemedicine-only and brick-and-mortar)	Form and Instruction	Modified	Repair queued
Form 5 Participant Experience Survey - Improving Antibiotic Use Cohort_Telemedicine-Only Organizations	Form and Instruction	Modified	Available
Form 4 Participant Experience Survey - Improving Antibiotic Use Cohort_Brick-and-Mortar Practices	Form and Instruction	Modified	Available
Form 4 Participant Experience Survey	Form and Instruction	Modified	Repair queued
Form 6 Attachment F: Participant Experience Survey_Cancer Diagnostic Process Cohort	Form and Instruction	Removed	Available
Form 6 Participant Experience Survey_Cancer Diagnostic Process Cohort	Form and Instruction	Removed	Repair queued
Form 5 Attachment E: Diagnostic Safety Supplement	Form and Instruction	Removed	Repair queued
Form 5 Diagnostic Safety Supplement	Form and Instruction	Removed	Repair queued
Form 3 Medical Office Survey on Patient Survey	Form and Instruction	Modified	Available
Form 3 The Medical Office Survey on Patient Safety Culture (MOSOPS)	Form and Instruction	Modified	Repair queued
Form 3 Attachment C: The Office Readiness Survey_Cancer Diagnostic Process Cohort	Form and Instruction	Removed	Available
Form 3 The Office Readiness Survey_Cancer Diagnostic Process Cohort	Form and Instruction	Removed	Available
Form 2 Structural Assessment - Improving Antibiotic Use Cohort - Telemedicine-Only Organizations	Form and Instruction	Modified	Available
Form 1 Structural Assessment-Improving Antibiotic Use Cohort-Brick and Mortar Practices	Form and Instruction	Modified	Available
Form 1 Structural Assessments	Form and Instruction	Modified	Repair queued
Supporting Statement A 0935-0265 The AHRQ Safety Program for Telemedicine - Improving Antibiotic Use.docx	Supporting Statement A	Uploaded 2024-07-12	Repair queued
Supporting Statement B AHRQ Safety Program for Telemedicine - Improving Antibiotic Use_071124.docx	Supporting Statement B	Uploaded 2024-07-11	Repair queued
Attachment H Instructions for Antibiotic Prescription Data Template_Antibiotic Use Cohort.docx	Supplementary Document	Uploaded 2024-07-10	Repair queued
Attachment J Schedule of Assessment Activities, 2024-2026.docx	Supplementary Document	Uploaded 2024-07-10	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
258926	Antibiotic Prescription Data Template_Antibiotic Use Cohort	Other-database	Modified
258925	Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort	Form and Instruction	Removed	Attachment J: Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort
258925	Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort	Form and Instruction	Removed
258922	Semi-Structured Qualitative Interviews (telemedicine-only and brick-and-mortar)	Form and Instruction	Modified	Draft Interview Guide
258922	Semi-Structured Qualitative Interviews (telemedicine-only and brick-and-mortar)	Form and Instruction	Modified
258921	Participant Experience Survey	Form and Instruction	Modified	Participant Experience Survey - Improving Antibiotic Use Cohort_Telemedicine-Only Organizations
258921	Participant Experience Survey	Form and Instruction	Modified	Participant Experience Survey - Improving Antibiotic Use Cohort_Brick-and-Mortar Practices
258921	Participant Experience Survey	Form and Instruction	Modified
258920	Participant Experience Survey_Cancer Diagnostic Process Cohort	Form and Instruction	Removed	Attachment F: Participant Experience Survey_Cancer Diagnostic Process Cohort
258920	Participant Experience Survey_Cancer Diagnostic Process Cohort	Form and Instruction	Removed
258919	Diagnostic Safety Supplement	Form and Instruction	Removed	Attachment E: Diagnostic Safety Supplement
258919	Diagnostic Safety Supplement	Form and Instruction	Removed
258916	The Medical Office Survey on Patient Safety Culture (MOSOPS)	Form and Instruction	Modified	Medical Office Survey on Patient Survey
258916	The Medical Office Survey on Patient Safety Culture (MOSOPS)	Form and Instruction	Modified
258915	The Office Readiness Survey_Cancer Diagnostic Process Cohort	Form and Instruction	Removed	Attachment C: The Office Readiness Survey_Cancer Diagnostic Process Cohort
258915	The Office Readiness Survey_Cancer Diagnostic Process Cohort	Form and Instruction	Removed
258913	Structural Assessments	Form and Instruction	Modified	Structural Assessment - Improving Antibiotic Use Cohort - Telemedicine-Only Organizations
258913	Structural Assessments	Form and Instruction	Modified	Structural Assessment-Improving Antibiotic Use Cohort-Brick and Mortar Practices
258913	Structural Assessments	Form and Instruction	Modified

ICR Details

OMB Control No: 0935-0265	ICR Reference No: 202407-0935-001
Status: Active	Previous ICR Reference No: 202303-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: The AHRQ Safety Program for Telemedicine: Improving Antibiotic Use
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/20/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/12/2024
Terms of Clearance: OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2027	36 Months From Approved	04/30/2026
Responses	5,508	0	11,100
Time Burden (Hours)	4,644	0	5,581
Cost Burden (Dollars)	0	0	0

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Abstract: This program aims to improve antibiotic use among telemedicine practices by implementing the AHRQ- and Johns Hopkins Armstrong Institute for Patient Safety and Quality (JHAI)-developed Comprehensive Unit-based Safety Program (CUSP) approach. The original materials submitted for OMB clearance included materials for two cohorts: the diagnostic process cohort and the improving antibiotic use cohort. The diagnostic process cohort was cancelled prior to the cohort’s start date. Therefore, this revision removes all references to the diagnostic process cohort including removal of all data collection tools specific to the cohort, updated versions of the annualized cost and burden tables, and removal of the reference to “Improving the Diagnostic Process” in the Safety Program name. Additionally, the previously submitted materials for OMB clearance included a single version of the Structural Assessment and Participant Experience Survey to be completed by all participants in the improving antibiotic use cohort. However, following pre-recruitment discussions with the program's Technical Expert Panel (TEP) and potential participants, it was learned that the target audience for the improving antibiotic use cohort is comprised of healthcare providers from both brick-and-mortar and telemedicine-only settings. Therefore, this revision proposes revisions to account for the differences in the two practice settings.

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Authorizing Statute(s): US Code: 42 USC 299b-2 Name of Law: Health Care 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:
	89 FR 33349	04/29/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 56875	07/11/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Antibiotic Prescription Data Template_Antibiotic Use Cohort
Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort	10	Attachment J: Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort
Diagnostic Safety Supplement	5	Attachment E: Diagnostic Safety Supplement
Participant Experience Survey	4, 5	Participant Experience Survey - Improving Antibiotic Use Cohort_Brick-and-Mortar Practices ,   Participant Experience Survey - Improving Antibiotic Use Cohort_Telemedicine-Only Organizations
Participant Experience Survey_Cancer Diagnostic Process Cohort	6	Attachment F: Participant Experience Survey_Cancer Diagnostic Process Cohort
Semi-Structured Qualitative Interviews (telemedicine-only and brick-and-mortar)	6	Draft Interview Guide
Structural Assessments	1, 2	Structural Assessment-Improving Antibiotic Use Cohort-Brick and Mortar Practices ,   Structural Assessment - Improving Antibiotic Use Cohort - Telemedicine-Only Organizations
The Medical Office Survey on Patient Safety Culture (MOSOPS)	3	Medical Office Survey on Patient Survey
The Office Readiness Survey_Cancer Diagnostic Process Cohort	3	Attachment C: The Office Readiness Survey_Cancer Diagnostic Process Cohort

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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	5,508	11,100	0	-4,467	-1,125	0
Annual Time Burden (Hours)	4,644	5,581	0	-755	-182	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 reduction in burden was achieved because the cancer diagnostic cohort was cancelled. While the updated overall burden and cost estimates decreased, the participant experience survey and EHR data collection increased. This is due to the reduced clearance period and the larger size of the Improving Antibiotic Use cohort compared to the Diagnostic Process Cohort. EHR Baseline data collection also includes an additional three months of data. This change extends the date range of the baseline data extracted from the EHR.

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Annual Cost to Federal Government: $584,877

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

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.     Yes

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: 07/12/2024

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