OMB control number

The AHRQ Safety Program for Telemedicine: Improving Antibiotic Use

OMB 0935-0265 · HHS/AHRQ.

OMB 0935-0265

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.

The latest form for The AHRQ Safety Program for Telemedicine: Improving Antibiotic Use expires 2027-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 10 Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort Form and Instruction
Form 6 Semi-Structured Qualitative Interviews (telemedicine-only and brick-and-mortar) Form and Instruction
Form 4 Participant Experience Survey Form and Instruction
Form 6 Participant Experience Survey_Cancer Diagnostic Process Cohort Form and Instruction
Form 5 Diagnostic Safety Supplement Form and Instruction
Form 3 The Medical Office Survey on Patient Safety Culture (MOSOPS) Form and Instruction
Form 3 The Office Readiness Survey_Cancer Diagnostic Process Cohort Form and Instruction
Form 1 Structural Assessments Form and Instruction
Supporting Statement A 0935-0265 The AHRQ Safety Program for Telemedicine - Improving Antibiotic Use.docx Supporting Statement A
Supporting Statement B AHRQ Safety Program for Telemedicine - Improving Antibiotic Use_071124.docx Supporting Statement B
Attachment H Instructions for Antibiotic Prescription Data Template_Antibiotic Use Cohort.docx Supplementary Document
Attachment J Schedule of Assessment Activities, 2024-2026.docx Supplementary Document
Antibiotic Prescription Data Template_Antibiotic Use Cohort Other-database
Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort Form and Instruction
Semi-Structured Qualitative Interviews (telemedicine-only and brick-and-mortar) Form and Instruction
Participant Experience Survey Form and Instruction
Participant Experience Survey_Cancer Diagnostic Process Cohort Form and Instruction
Diagnostic Safety Supplement Form and Instruction
The Medical Office Survey on Patient Safety Culture (MOSOPS) Form and Instruction
The Office Readiness Survey_Cancer Diagnostic Process Cohort Form and Instruction
Structural Assessments Form and Instruction

All Historical Document Collections

202407-0935-001	Revision of a currently approved collection	2024-07-12
202303-0935-001 Approved without change	New collection (Request for a new OMB Control Number)	2023-03-20

OMB Details

Structural Assessments

Federal Enterprise Architecture: Health - Health Care Services

Form 1	Structural Assessment-Improving Antibiotic Use Cohort-Brick and Mortar Practices	Fillable Fileable	Form and instruction
Form 2	Structural Assessment - Improving Antibiotic Use Cohort - Telemedicine-Only Organizations	Fillable Fileable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.