One-Page Justification

Approval Request Under the “Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery” (OMB Control Number: 0704-0553)

TITLE OF INFORMATION COLLECTION: Care Coordination Pilot - Patient Navigator Project Patient Experience Survey

PURPOSE: The DHA, under the Deputy Assistant Director for Health Care Operations, is conducting a care coordination pilot to study the effectiveness of the patient navigator (PN) model. This pilot aims to provide patients with seamless experience in coordinating specialty care referrals through the PN. The PN will assist patients booking specialty care appointments with civilian network facilities by communicating directly with the patients. The patient experience survey will be used to capture patient feedback on the patient navigator program to evaluate the program’s effectiveness. Patient feedback will be one of many inputs (e.g., referral utilization, average days to care, booked appointments, ambulatory specialty care leakage, and funding) used to inform the design of future state Integrated Referral Management and Appointing Center (IRMAC).

DESCRIPTION OF RESPONDENTS: All individuals surveyed had experience with the PN program. The PN program is piloted across four sites including seven parent military medical treatment facilities (MTF): Army Community Hospital Evans-Carson, 10th Medical Group (MDG)-Academy, 21 MDG-Peterson, 460 MDG-Buckley, Eisenhower AMC, 99 MDG-Nellis, and ACH Blanchfield-Ft Campbell. Respondents must meet all the following criteria: 1) enrolled at one of the above-mentioned MTFs, 2) directly contacted by a patient navigator, and 3) accepted the patient navigator’s support. Targeted respondents will be sent a survey to their personal email addresses and/or through a message in the MHS GENESIS Patient Portal. No protected health information and personally identifiable information will be collected in this survey.

An estimate of 12 patients will be assisted daily at each pilot site. The estimated duration for the first pilot site is about 90 business days while the remaining sites will be piloted for about 70 days. Across four pilot sites, this means an approximate of 3,600 patients will be assisted. Assuming a response rate of 25%, there will be around 900 respondents.

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: Julie Pruitt, Healthcare Operations/Integrated Healthcare Delivery Division

Assistant Director for Healthcare Administration

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

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No

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	Burden
Individuals (patients)	900	5 mins	75 hours
Totals	900	5 mins	75 hours

PUBLIC COST: The estimated annual cost to the public is $2,232.

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?

After accepting support and receiving assistance from a Patient Navigator, this survey will be sent to the patient, requesting feedback on their experience. Examples of patients that a Patient Navigator will reach out to assist include: 1) those who have been deferred out to the private sector for specialty care and have yet to schedule their appointment, 2) those with a referral that has an authorization issue, delaying their care, and 3) those with a referral that has an error, delaying their care. While each pilot site is unique in the scope of patients that will be assisted (e.g., specific beneficiary types like Active Duty patients), the Patient Navigator will only assist in referrals for two to three specialties/sub-specialties at each pilot site. The current list of specialties or sub-specialties across the entire pilot include Behavioral Health, Gastroenterology, Hematology Oncology, and OB-GYN.

Administration of the Instrument

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

[X] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

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

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