Agency Information Collection Activities: Proposed Collection; Comment Request, 51484-51487 [E8-20315]

Download as PDF 51484 Federal Register / Vol. 73, No. 171 / Wednesday, September 3, 2008 / Notices A under ‘‘CERHR Reports & Monographs’’ or directly at http:// cerhr.niehs.nih.gov/chemicals/ bisphenol/bisphenol-eval.html.) SUPPLEMENTARY INFORMATION: sroberts on PROD1PC70 with NOTICES Background Information on Bisphenol A Bisphenol A (CAS RN: 80–05–7) is a high production volume chemical used primarily in the production of polycarbonate plastics and epoxy resins. Polycarbonate plastics are used in some food and drink containers; the resins are used as lacquers to coat metal products such as food cans, bottle tops, and water supply pipes. To a lesser extent bisphenol A is used in the production of polyester resins, polysulfone resins, polyacrylate resins, and flame retardants. In addition, bisphenol A is used in the processing of polyvinyl chloride plastic. Some polymers used in dental sealants and composites may contribute to bisphenol A exposures. The primary source of exposure to bisphenol A for most people is assumed to occur through the diet. The highest estimated daily intakes of bisphenol A in the general population occur in infants and children. CERHR selected bisphenol A for evaluation because of (1) widespread human exposure, (2) public concern for possible health effects, (3) high production volume, and (4) evidence of reproductive and developmental toxicity in laboratory animal studies. Background Information on the CERHR The NTP established CERHR in 1998 (Federal Register: December 14, 1998: Vol. 63, No. 239, page 68782). CERHR is a publicly accessible resource for information about adverse reproductive and/or developmental health effects associated with exposure to environmental and/or occupational exposures. CERHR follows a formal process for the evaluation of selected chemicals that includes opportunities for public input. CERHR invites the nomination of agents for review or scientists for its expert registry. Information about CERHR and the nomination process can be obtained from its homepage (http:// cerhr.niehs.nih.gov) or by contacting Dr. Michael Shelby, CERHR Director (see ADDRESSES). CERHR selects chemicals for evaluation based upon several factors including production volume, potential for human exposure from use and occurrence in the environment, extent of public concern, and extent of data from reproductive and developmental toxicity studies. Expert panels conduct scientific evaluations of agents selected by CERHR in public VerDate Aug<31>2005 22:59 Sep 02, 2008 Jkt 214001 forums. Following these evaluations, CERHR prepares the NTP–CERHR monograph on the agent evaluated. The monograph is transmitted to appropriate federal and state agencies and made available to the public. Dated: August 20, 2008. Samuel H. Wilson, Acting Director, National Institute of Environmental Health Sciences and National Toxicology Program. [FR Doc. E8–20297 Filed 9–2–08; 8:45 am] BILLING CODE 4140–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Agency Information Collection Activities: Proposed Collection; Comment Request Agency for Healthcare Research and Quality, HHS. ACTION: Notice. AGENCY: SUMMARY: This notice announces the intention of the Agency for Healthcare Research and Quality (AHRQ) to request that the Office of Management and Budget (OMB) approve the proposed information collection project: ‘‘Study of Factors Influencing Consumer Choices Among Health Plans and Clinicians.’’ In accordance with the Paperwork Reduction Act of 1995, Public Law 104–13 (44 U.S.C. 3506(c)(2)(A)), AHRQ invites the public to comment on this proposed information collection. DATES: Comments on this notice must be received by November 3, 2008. ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, Reports Clearance Officer, AHRQ, by email at doris.lefkowitz@ahrq.hhs.gov. Copies of the proposed collection plans, data collection instruments, and specific details on the estimated burden can be obtained from the AHRQ Reports Clearance Officer. FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports Clearance Officer, (301) 427–1477, or by e-mail at doris.lefkowitz@ahrq.hhs.gov. SUPPLEMENTARY INFORMATION: Proposed Project ‘‘Study of Factors Influencing Consumer Choices Among Health Plans and Clinicians’’ This study will use an experimental design to determine factors that influence consumer understanding and use of performance information to select among health plans and clinicians. PO 00000 Frm 00048 Fmt 4703 Sfmt 4703 Performance reports on health plans and individual providers have become increasingly available in recent years, but there is little evidence regarding how consumers understand and use different types of performance information to make choices. The study will include two parallel experiments, one designed to assess factors influencing choice of health plans and one designed to assess factors influencing choice of individual doctors. Both experiments will present a panel of online consumers with a simulated Web-based performance report. Study subjects will answer a series of pre-test questions, and then be directed to a Web site with a simulated report (for either health plans or doctors) where they will view various types of performance information, go through the process of selecting either a health plan or a doctor, and then complete the experiment by answering a series of post-test questions about how they made their selection. The categories of performance information to be included in the Web reports will be derived from patient experience survey results using Consumer Assessment of Healthcare Providers and Systems (CAHPS) composite measures, clinical process measures, personal anecdotes based on patient or enrollee experiences, and the frequency of different types of enrollee complaints or grievances (in the plan experiment only). The results of this study will be used to develop recommendations for helping consumers to better understand and more effectively use complex information to select health plans and providers, with the aim of making performance information less burdensome and more accessible, useful, and transparent to the public. The simulated Web-based reports will be made available as examples for other report developers to use. This study is being conducted pursuant to AHRQ’s statutory mandate to promote health care quality improvement by conducting and supporting research that develops and presents scientific evidence regarding all aspects of health care, 42 U.S.C. 299(b)(1), and to conduct research on health care and on systems for the delivery of such health care, 42 U.S.C. 299a. Method of Collection Participants in this study will be recruited through the Knowledge Networks national online panel of consumers. For both the health plan and clinician choice experiments, study subjects will be randomly assigned to one of several arms (described below) E:\FR\FM\03SEN1.SGM 03SEN1 Federal Register / Vol. 73, No. 171 / Wednesday, September 3, 2008 / Notices sroberts on PROD1PC70 with NOTICES that vary according to the type and complexity of performance information and the size of the choice set (number of plans or doctors) included in the Web report. Participants will complete the experiment through a secure online connection from their homes. Clinician Choice Experimental Design In each of the six arms, study participants will see a web page labeled ‘‘Performance Overview’’ that presents performance information for a set of primary care doctors in a way that allows them to compare doctor ratings. Performance is summarized by assigning one to five stars to show how each doctor compares with others in the same zip code area. Participants can click on hyperlinks or a tab to see more detailed results. The experimental arms differ in the type and amount of performance information presented and the number of doctors listed, as described below: (1) Baseline/Control Arm: participants see only ‘‘Patient Survey Results’’ for each of 12 doctors in this arm. This includes a summary measure on the Performance Overview page and more detailed measures corresponding to CAHPS composites and an overall doctor rating on the drill-down page. (2) Experimental Arm #1: Augmented Quantified Performance Measures: In this arm participants will also see ‘‘Patient Survey Results’’ on 12 doctors. In addition, they will see a summary clinical performance measure labeled ‘‘Medical Quality Scores.’’ The drilldown page shows that this is based on clinical indicators for prevention and screening, care for asthma, care for diabetes, and care for heart disease. (3) Experimental Arm #2: CAHPS plus Anecdotes: In this arm, participants will again be presented with ‘‘Patient Survey Results’’ on 12 doctors. In addition, for each doctor, they will see a tab labeled ‘‘Patient Comments.’’ By clicking on this tab, they can see from four to six patient comments describing patients’ experiences with each doctor. Participants in this arm will not see clinical performance scores. (4) Experimental Arm #3: Augmented Quantified Performance Measures Plus Anecdotes: In this arm participants will be presented with all three types of information on 12 doctors: ‘‘Patient Survey Results,’’ ‘‘Medical Quality Scores’’, and ‘‘Patient Comments.’’ (5) Experimental Arm #4: CAHPS plus Anecdotes and Larger Choice Set: In this arm participants will be presented with ‘‘Patient Survey Results’’ and ‘‘Patient Comments’’ on 24 doctors. (6) Experimental Arm #5: Maximum Cognitive Load: Large Choice Set and VerDate Aug<31>2005 22:59 Sep 02, 2008 Jkt 214001 Three Measures of Performance: In this arm, participants are presented with all three types of information on 24 doctors: ‘‘Patient Survey Results,’’ ‘‘Medical Quality Scores,’’ and ‘‘Patient Comments.’’ The goals of the experiment are to assess the process of consumer choice and the extent to which CAHPS-type measures are consulted, and to examine how consumers respond to different types of information about doctor quality, including quantitative patient experience measures, anecdotal reports from individual patients, and clinical performance indicators. The post-test questionnaire will elicit participants’ understanding and impressions of the material they saw on the Web site and inquire about how they made their choice. Therefore, the post-test questions will differ somewhat across experimental arms. Health Plan Choice Experimental Design The design of the health plan choice experiment has a comparable architecture to the clinician-choice experiment, but makes choices more challenging by adding more dimensions of performance measures within a smaller choice set. (These distinctions between informed clinician choice and informed plan choice replicate the information currently available to consumers over the internet.) In each of the six arms, study participants will see a web page labeled ‘‘Performance Overview’’ that presents performance information for a set of health plans in a way that allows them to compare plan ratings. Performance is summarized by assigning one to five stars to show how each plan compares with others in the same community. Participants can click on hyperlinks or a tab to see more detailed results. The experimental arms differ in the type and amount of performance information presented and the number of plans listed, as described below: (1) Baseline/Control Arm: participants see only ‘‘Patient Survey Results’’ for each of 4 plans in this arm. This includes a summary measure on the Performance Overview page and more detailed measures corresponding to CAHPS composites and an overall plan ratings on the drill-down page. (2) Experimental Arm #1: Augmented Quantified Performance Measures: In this arm participants will also see ‘‘Patient Survey Results’’ on four plans. In addition, they will see two summary clinical performance measures labeled ‘‘Health Care Quality Scores,’’ which will consist of selected Health Care Effectiveness Data and Information Set PO 00000 Frm 00049 Fmt 4703 Sfmt 4703 51485 (HEDIS) measures, one for preventive care, and one for the treatment of chronic conditions. The drill-down page for prevention will show preventive care scores of regular physical exams, and screening for three common medical conditions. The drill down page for treatment will include summary measures for heart problems, asthma, diabetes, and arthritis. A summary score for the reported rate of consumer complaints will also be included, with a drill down reporting rating for the four most common causes of complaints, with the categories based on actual data from three states. (3) Experimental Arm #2: CAHPS plus Anecdotes: In this arm, participants will again be presented with ‘‘Patient Survey Results’’ on four plans. In addition, for each plan, they will see a tab labeled ‘‘Patient Comments.’’ By clicking on this tab, they can see from four to six patient comments describing patients’ experiences with each plan. Participants in this arm will not see quality performance or rates of patient complaints scores. (4) Experimental Arm #3: Augmented Quantified Performance Measures Plus Anecdotes: In this arm participants will be presented with all four types of information for four plans: ‘‘Patient Survey Results,’’ ‘‘Health Care Quality Scores’’, ‘‘Patient Complaint Rates’’ and ‘‘Patient Comments.’’ (5) Experimental Arm #4: CAHPS plus Anecdotes and Larger Choice Set: In this arm participants will be presented with ‘‘Patient Survey Results’’ and ‘‘Patient Comments’’ on 12 plans. (6) Experimental Arm #5: Maximum Cognitive Load: Large Choice Set and Five Measures of Performance: In this arm, participants are presented with all three types of information: ‘‘Patient Survey Results,’’ ‘‘Health Care Quality Scores’’ (both prevention and treatment), ‘‘Patient Complaint Rates’’ and ‘‘Patient Comments’’ on 12 plans. The goal of these experiments is to assess the process of consumer choice and the extent to which CAHPS-type measures are consulted, and to examine how consumers respond to different types of information about plan performance, including quantitative patient experience measures, anecdotal reports from individual patients, frequency of consumer complaints, and clinical performance indicators. The post-test questionnaire will elicit participants’ understanding and impressions of the material they saw on the Web site and inquire about how they made their choice. Therefore, the posttest questions will differ somewhat across experimental arms. E:\FR\FM\03SEN1.SGM 03SEN1 51486 Federal Register / Vol. 73, No. 171 / Wednesday, September 3, 2008 / Notices Estimated Annual Respondent Burden Exhibit 1 shows the estimated annualized burden hours for the respondents’ time to participate in this experiment. This experiment will not exceed one year. All participants will complete the pre-test which is estimated to require 5 minutes. As explained above, the experimental Web site varies by experimental arm, however, each participant is expected to require about 10 minutes to review the information on the site. The baseline/control post-test will be completed by 170 participants and will require about 7 minutes to complete. Both the experimental arm #1 and #2 post-test will be completed by 166 participants each and will take about 8 minutes. Both the experimental arm #3 and #4 post-test will be completed by 166 participants each and will require about 12 minutes to complete. The experimental arm #6 post-test will be completed by 166 participants and will require about 14 minutes to complete. The total burden hours are estimated to be 838 hours. Exhibit 2 shows the respondents’ cost burden for their time to participate in this experiment. The total cost burden is estimated to be $16,142. EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS Number of responses Experimental group Clinician Choice Experiment: Pretest ...................................................................................................... Experimental Web site ............................................................................. Baseline/Control Post-test ........................................................................ Experimental Arm #1 Post-test ................................................................. Experimental Arm #2 Post-test ................................................................. Experimental Arm #3 Post-test ................................................................. Experimental Arm #4 Post-test ................................................................. Experimental Arm #5 Post-test ................................................................. Health Plan Choice Experiment: Pretest ...................................................................................................... Experimental Web site ............................................................................. Baseline/Control Post-test ........................................................................ Experimental Arm #1 Post-test ................................................................. Experimental Arm #2 Post-test ................................................................. Experimental Arm #3 Post-test ................................................................. Experimental Arm #4 Post-test ................................................................. Experimental Arm #5 Post-test ................................................................. Number of responses per respondent Hours per response Total burden hours 1,000 1,000 170 166 166 166 166 166 5/60 10/60 7/60 8/60 8/60 12/60 12/60 14/60 83 167 20 22 22 33 33 39 1,000 1,000 170 166 166 166 166 166 1 1 1 1 1 1 1 1 5/60 10/60 7/60 8/60 8/60 12/60 12/60 14/60 83 167 20 22 22 33 33 39 6,000 Total ................................................................................................... 1 1 1 1 1 1 1 1 na na 838 EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN Number of responses Experimental group Clinician Choice Experiment: Pretest ...................................................................................................... Experimental Web site ............................................................................. Baseline/Control Post-test ........................................................................ Experimental Arm #1 Post-test ................................................................. Experimental Arm #2 Post-test ................................................................. Experimental Arm #3 Post-test ................................................................. Experimental Arm #4 Post-test ................................................................. Experimental Arm #5 Post-test ................................................................. Health Plan Choice Experiment: Pretest ...................................................................................................... Experimental Web site ............................................................................. Baseline/Control Post-test ........................................................................ Experimental Arm #1 Post-test ................................................................. Experimental Arm #2 Post-test ................................................................. Experimental Arm #3 Post-test ................................................................. Experimental Arm #4 Post-test ................................................................. Experimental Arm #5 Post-test ................................................................. Total ................................................................................................... Total burden hours Average hourly wage rate* Total cost burden 1,000 1,000 170 166 166 166 166 166 83 167 20 22 22 33 33 39 $19.26 19.26 19.26 19.26 19.26 19.26 19.26 19.26 $1,599 3,216 385 424 424 636 636 751 1,000 1,000 170 166 166 166 166 166 83 167 20 22 22 33 33 39 19.26 19.26 19.26 19.26 19.26 19.26 19.26 19.26 1,599 3,216 385 424 424 636 636 751 6,000 838 na 16,142 sroberts on PROD1PC70 with NOTICES *Based upon the mean of the average wages, National Compensation Survey: Occupational wages in the United States 2006, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’ Estimated Annual Costs to the Federal Government The total cost to the Federal Government for developing and VerDate Aug<31>2005 22:59 Sep 02, 2008 Jkt 214001 conducting both the health plan and clinician choice components of this study is $844,000, including the cost of designing the experiments, developing the simulated Web-based reports, PO 00000 Frm 00050 Fmt 4703 Sfmt 4703 conducting usability testing of the Webreports, pilot testing the experiment, collecting the data, analyzing the data, preparing reports and papers for journal submission, and the cost for AHRQ staff E:\FR\FM\03SEN1.SGM 03SEN1 Federal Register / Vol. 73, No. 171 / Wednesday, September 3, 2008 / Notices to oversee the project; see Exhibit 3. The annualized cost for this two year project is $422,000. EXHIBIT 3—PROJECT COST COMPONENTS Cost components sroberts on PROD1PC70 with NOTICES Experimental design ................... Development of simulated Webbased reports .......................... Pilot testing ................................. Usability testing of Web-based reports ..................................... Data collection via Knowledge Networks ................................. Data analysis .............................. Preparation of reports and journal papers ............................... AHRQ project management DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES) Stored Cost Biologic Specimens: Guidelines for estimate Proposals To Use Samples and $168,900 Proposed Cost Schedule Centers for Disease Control and Prevention, Department of Health and Human Services. ACTION: Notice and request for 56,300 comments. 157,900 56,000 AGENCY: 126,000 56,300 SUMMARY: The National Health and Nutrition Examination Survey 112,600 (NHANES) is a program of periodic 110,000 surveys conducted by the National Center for Health Statistics (NCHS) of Total ..................................... 844,000 the Centers for Disease Control and Prevention (CDC). Examination surveys conducted since 1960 by NCHS, have Request for Comments provided national estimates of health In accordance with the above-cited and nutritional status of the United Paperwork Reduction Act legislation, States civilian non-institutionalized comments on AHRQ’s information population. To add to the large amount collection are requested with regard to of information collected for the purpose any of the following: (a) Whether the of describing the health of the proposed collection of information is population in the most recent survey, necessary for the proper performance of serum, urine and limited plasma samples were collected and stored for AHRQ health care research and health future research projects. Specimens are care information dissemination currently available from NHANES III functions, including whether the (conducted from 1988–1994) and from information will have practical utility; NHANES 1999+. In 1999, NHANES (b) the accuracy of AHRQ’s estimate of became a continuous survey with data burden (including hours and costs) of release every two years. Specimens are the proposed collection(s) of available from two year survey cycles information; (c) ways to enhance the after the demographic file has been quality, utility, and clarity of the released to the public. Participants in information to be collected; and (d) the survey that began in 1999 signed a ways to minimize the burden of the separate consent document agreeing to collection of information upon the specimen storage allowing their biologic respondents, including the use of specimens to be used for approved automated collection techniques or research projects. other forms of information technology. Specimens are stored in two Comments submitted in response to Specimen Banks. Surplus samples that this notice will be summarized and were initially used for laboratory assays included in the surveys, have since been included in the Agency’s subsequent stored at ¥70° C and have been through request for OMB approval of the at least two freeze-thaw cycles. They are proposed information collection. All stored at a commercial repository under comments will become a matter of contract to NCHS. In addition, on public record. average, six vials of sera were also Dated: August 26, 2008. stored in vapor-phase liquid nitrogen at Carolyn M. Clancy, the CDC and ATSTR Specimen Director. Packaging, Inventory and Repository (CASPIR) Repository in Lawrenceville, [FR Doc. E8–20315 Filed 9–2–08; 8:45 am] GA. These specimens have not BILLING CODE 4160–90–M undergone a freeze-thaw cycle. The CASPIR Repository is considered a longterm repository for the NHANES specimens. NCHS is making both of these collections available for research proposals. The research proposals that VerDate Aug<31>2005 22:59 Sep 02, 2008 Jkt 214001 PO 00000 Frm 00051 Fmt 4703 Sfmt 4703 51487 can use the surplused specimens will receive higher priority. Proposals that request the specimens in CASPIR need to justify the use of the unthawed specimens. The purpose of this notice is to request comments on this program and the proposed cost schedule. After consideration of comments submitted, CDC will finalize and publish the cost schedule and accept proposals for use of the NHANES stored biologic samples. Please go to http://www.cdc.gov/nchs/ about/major/nhanes/serum1b.htm for final proposal guidelines. All interested researchers are encouraged to submit proposals. No funding is provided as part of this solicitation. Samples will not be provided to those projects requiring funding until the project has received funds. Approved projects that do not obtain funding will be canceled. A more complete description of this program follows. DATES: • Comment Receipt Date: October 3, 2008. • Invitation to Submit Proposals: Can be submitted on an ongoing basis. • Scientific Review Date: Within two months of proposal submission. • Institutional Review Date: Within one month of final proposal acceptance. • Anticipated distribution of samples: One month after IRB approval. ADDRESSES: To send comments and to request information, contact: Dr. Geraldine McQuillan, Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Room 4204, Hyattsville, MD 20782, Phone: 301–458–4371, Fax: 301–458–4028, Email gmm2@cdc.gov. Internet: http:// www.cdc.gov/nchs/about/major/ nhanes/serum1b.htm. Authority: Sections 301, 306 and 308 of the Public Health Service Act (42 U.S.C. 241, 242k and 242M). The goals of NHANES are: (1) To estimate the number and percent of persons in the U.S. population and designated subgroups with selected diseases and risk factors; (2) to monitor trends in the prevalence, awareness, treatment and control of selected diseases; (3) to monitor trends in risk behaviors and environmental exposures; (4) to analyze risk factors for selected diseases; (5) to study the relationship between diet, nutrition and health; (6) to explore emerging public health issues and new technologies; and, (7) to establish and maintain a national probability sample SUPPLEMENTARY INFORMATION: E:\FR\FM\03SEN1.SGM 03SEN1

Agencies

[Federal Register Volume 73, Number 171 (Wednesday, September 3, 2008)]
[Notices]
[Pages 51484-51487]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-20315]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice announces the intention of the Agency for 
Healthcare Research and Quality (AHRQ) to request that the Office of 
Management and Budget (OMB) approve the proposed information collection 
project: ``Study of Factors Influencing Consumer Choices Among Health 
Plans and Clinicians.'' In accordance with the Paperwork Reduction Act 
of 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)), AHRQ invites the 
public to comment on this proposed information collection.

DATES: Comments on this notice must be received by November 3, 2008.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by email at 
doris.lefkowitz@ahrq.hhs.gov.
    Copies of the proposed collection plans, data collection 
instruments, and specific details on the estimated burden can be 
obtained from the AHRQ Reports Clearance Officer.

FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports 
Clearance Officer, (301) 427-1477, or by e-mail at 
doris.lefkowitz@ahrq.hhs.gov.

SUPPLEMENTARY INFORMATION:

Proposed Project

    ``Study of Factors Influencing Consumer Choices Among Health Plans 
and Clinicians''
    This study will use an experimental design to determine factors 
that influence consumer understanding and use of performance 
information to select among health plans and clinicians. Performance 
reports on health plans and individual providers have become 
increasingly available in recent years, but there is little evidence 
regarding how consumers understand and use different types of 
performance information to make choices.
    The study will include two parallel experiments, one designed to 
assess factors influencing choice of health plans and one designed to 
assess factors influencing choice of individual doctors. Both 
experiments will present a panel of online consumers with a simulated 
Web-based performance report. Study subjects will answer a series of 
pre-test questions, and then be directed to a Web site with a simulated 
report (for either health plans or doctors) where they will view 
various types of performance information, go through the process of 
selecting either a health plan or a doctor, and then complete the 
experiment by answering a series of post-test questions about how they 
made their selection.
    The categories of performance information to be included in the Web 
reports will be derived from patient experience survey results using 
Consumer Assessment of Healthcare Providers and Systems (CAHPS) 
composite measures, clinical process measures, personal anecdotes based 
on patient or enrollee experiences, and the frequency of different 
types of enrollee complaints or grievances (in the plan experiment 
only).
    The results of this study will be used to develop recommendations 
for helping consumers to better understand and more effectively use 
complex information to select health plans and providers, with the aim 
of making performance information less burdensome and more accessible, 
useful, and transparent to the public. The simulated Web-based reports 
will be made available as examples for other report developers to use. 
This study is being conducted pursuant to AHRQ's statutory mandate to 
promote health care quality improvement by conducting and supporting 
research that develops and presents scientific evidence regarding all 
aspects of health care, 42 U.S.C. 299(b)(1), and to conduct research on 
health care and on systems for the delivery of such health care, 42 
U.S.C. 299a.

Method of Collection

    Participants in this study will be recruited through the Knowledge 
Networks national online panel of consumers. For both the health plan 
and clinician choice experiments, study subjects will be randomly 
assigned to one of several arms (described below)

[[Page 51485]]

that vary according to the type and complexity of performance 
information and the size of the choice set (number of plans or doctors) 
included in the Web report. Participants will complete the experiment 
through a secure online connection from their homes.

Clinician Choice Experimental Design

    In each of the six arms, study participants will see a web page 
labeled ``Performance Overview'' that presents performance information 
for a set of primary care doctors in a way that allows them to compare 
doctor ratings. Performance is summarized by assigning one to five 
stars to show how each doctor compares with others in the same zip code 
area. Participants can click on hyperlinks or a tab to see more 
detailed results. The experimental arms differ in the type and amount 
of performance information presented and the number of doctors listed, 
as described below:
    (1) Baseline/Control Arm: participants see only ``Patient Survey 
Results'' for each of 12 doctors in this arm. This includes a summary 
measure on the Performance Overview page and more detailed measures 
corresponding to CAHPS composites and an overall doctor rating on the 
drill-down page.
    (2) Experimental Arm #1: Augmented Quantified Performance Measures: 
In this arm participants will also see ``Patient Survey Results'' on 12 
doctors. In addition, they will see a summary clinical performance 
measure labeled ``Medical Quality Scores.'' The drill-down page shows 
that this is based on clinical indicators for prevention and screening, 
care for asthma, care for diabetes, and care for heart disease.
    (3) Experimental Arm #2: CAHPS plus Anecdotes: In this arm, 
participants will again be presented with ``Patient Survey Results'' on 
12 doctors. In addition, for each doctor, they will see a tab labeled 
``Patient Comments.'' By clicking on this tab, they can see from four 
to six patient comments describing patients' experiences with each 
doctor. Participants in this arm will not see clinical performance 
scores.
    (4) Experimental Arm #3: Augmented Quantified Performance Measures 
Plus Anecdotes: In this arm participants will be presented with all 
three types of information on 12 doctors: ``Patient Survey Results,'' 
``Medical Quality Scores'', and ``Patient Comments.''
    (5) Experimental Arm #4: CAHPS plus Anecdotes and Larger Choice 
Set: In this arm participants will be presented with ``Patient Survey 
Results'' and ``Patient Comments'' on 24 doctors.
    (6) Experimental Arm #5: Maximum Cognitive Load: Large Choice Set 
and Three Measures of Performance: In this arm, participants are 
presented with all three types of information on 24 doctors: ``Patient 
Survey Results,'' ``Medical Quality Scores,'' and ``Patient Comments.''
    The goals of the experiment are to assess the process of consumer 
choice and the extent to which CAHPS-type measures are consulted, and 
to examine how consumers respond to different types of information 
about doctor quality, including quantitative patient experience 
measures, anecdotal reports from individual patients, and clinical 
performance indicators. The post-test questionnaire will elicit 
participants' understanding and impressions of the material they saw on 
the Web site and inquire about how they made their choice. Therefore, 
the post-test questions will differ somewhat across experimental arms.

Health Plan Choice Experimental Design

    The design of the health plan choice experiment has a comparable 
architecture to the clinician-choice experiment, but makes choices more 
challenging by adding more dimensions of performance measures within a 
smaller choice set. (These distinctions between informed clinician 
choice and informed plan choice replicate the information currently 
available to consumers over the internet.) In each of the six arms, 
study participants will see a web page labeled ``Performance Overview'' 
that presents performance information for a set of health plans in a 
way that allows them to compare plan ratings. Performance is summarized 
by assigning one to five stars to show how each plan compares with 
others in the same community. Participants can click on hyperlinks or a 
tab to see more detailed results. The experimental arms differ in the 
type and amount of performance information presented and the number of 
plans listed, as described below:
    (1) Baseline/Control Arm: participants see only ``Patient Survey 
Results'' for each of 4 plans in this arm. This includes a summary 
measure on the Performance Overview page and more detailed measures 
corresponding to CAHPS composites and an overall plan ratings on the 
drill-down page.
    (2) Experimental Arm #1: Augmented Quantified Performance Measures: 
In this arm participants will also see ``Patient Survey Results'' on 
four plans. In addition, they will see two summary clinical performance 
measures labeled ``Health Care Quality Scores,'' which will consist of 
selected Health Care Effectiveness Data and Information Set (HEDIS) 
measures, one for preventive care, and one for the treatment of chronic 
conditions. The drill-down page for prevention will show preventive 
care scores of regular physical exams, and screening for three common 
medical conditions. The drill down page for treatment will include 
summary measures for heart problems, asthma, diabetes, and arthritis. A 
summary score for the reported rate of consumer complaints will also be 
included, with a drill down reporting rating for the four most common 
causes of complaints, with the categories based on actual data from 
three states.
    (3) Experimental Arm #2: CAHPS plus Anecdotes: In this arm, 
participants will again be presented with ``Patient Survey Results'' on 
four plans. In addition, for each plan, they will see a tab labeled 
``Patient Comments.'' By clicking on this tab, they can see from four 
to six patient comments describing patients' experiences with each 
plan. Participants in this arm will not see quality performance or 
rates of patient complaints scores.
    (4) Experimental Arm #3: Augmented Quantified Performance Measures 
Plus Anecdotes: In this arm participants will be presented with all 
four types of information for four plans: ``Patient Survey Results,'' 
``Health Care Quality Scores'', ``Patient Complaint Rates'' and 
``Patient Comments.''
    (5) Experimental Arm #4: CAHPS plus Anecdotes and Larger Choice 
Set: In this arm participants will be presented with ``Patient Survey 
Results'' and ``Patient Comments'' on 12 plans.
    (6) Experimental Arm #5: Maximum Cognitive Load: Large Choice Set 
and Five Measures of Performance: In this arm, participants are 
presented with all three types of information: ``Patient Survey 
Results,'' ``Health Care Quality Scores'' (both prevention and 
treatment), ``Patient Complaint Rates'' and ``Patient Comments'' on 12 
plans.
    The goal of these experiments is to assess the process of consumer 
choice and the extent to which CAHPS-type measures are consulted, and 
to examine how consumers respond to different types of information 
about plan performance, including quantitative patient experience 
measures, anecdotal reports from individual patients, frequency of 
consumer complaints, and clinical performance indicators. The post-test 
questionnaire will elicit participants' understanding and impressions 
of the material they saw on the Web site and inquire about how they 
made their choice. Therefore, the post-test questions will differ 
somewhat across experimental arms.

[[Page 51486]]

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
respondents' time to participate in this experiment. This experiment 
will not exceed one year. All participants will complete the pre-test 
which is estimated to require 5 minutes. As explained above, the 
experimental Web site varies by experimental arm, however, each 
participant is expected to require about 10 minutes to review the 
information on the site. The baseline/control post-test will be 
completed by 170 participants and will require about 7 minutes to 
complete. Both the experimental arm 1 and 2 post-test 
will be completed by 166 participants each and will take about 8 
minutes. Both the experimental arm 3 and 4 post-test 
will be completed by 166 participants each and will require about 12 
minutes to complete. The experimental arm 6 post-test will be 
completed by 166 participants and will require about 14 minutes to 
complete. The total burden hours are estimated to be 838 hours.
    Exhibit 2 shows the respondents' cost burden for their time to 
participate in this experiment. The total cost burden is estimated to 
be $16,142.

                                  Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
                                                                     Number of
               Experimental group                    Number of     responses per     Hours per     Total burden
                                                     responses      respondent       response          hours
----------------------------------------------------------------------------------------------------------------
Clinician Choice Experiment:
    Pretest.....................................           1,000               1            5/60              83
    Experimental Web site.......................           1,000               1           10/60             167
    Baseline/Control Post-test..................             170               1            7/60              20
    Experimental Arm 1 Post-test.......             166               1            8/60              22
    Experimental Arm 2 Post-test.......             166               1            8/60              22
    Experimental Arm 3 Post-test.......             166               1           12/60              33
    Experimental Arm 4 Post-test.......             166               1           12/60              33
    Experimental Arm 5 Post-test.......             166               1           14/60              39
Health Plan Choice Experiment:
    Pretest.....................................           1,000               1            5/60              83
    Experimental Web site.......................           1,000               1           10/60             167
    Baseline/Control Post-test..................             170               1            7/60              20
    Experimental Arm 1 Post-test.......             166               1            8/60              22
    Experimental Arm 2 Post-test.......             166               1            8/60              22
    Experimental Arm 3 Post-test.......             166               1           12/60              33
    Experimental Arm 4 Post-test.......             166               1           12/60              33
    Experimental Arm 5 Post-test.......             166               1           14/60              39
                                                 ---------------------------------------------------------------
        Total...................................           6,000              na              na             838
----------------------------------------------------------------------------------------------------------------


                                   Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
                                                     Number of     Total burden   Average hourly    Total cost
               Experimental group                    responses         hours        wage rate*        burden
----------------------------------------------------------------------------------------------------------------
Clinician Choice Experiment:
    Pretest.....................................           1,000              83          $19.26          $1,599
    Experimental Web site.......................           1,000             167           19.26           3,216
    Baseline/Control Post-test..................             170              20           19.26             385
    Experimental Arm 1 Post-test.......             166              22           19.26             424
    Experimental Arm 2 Post-test.......             166              22           19.26             424
    Experimental Arm 3 Post-test.......             166              33           19.26             636
    Experimental Arm 4 Post-test.......             166              33           19.26             636
    Experimental Arm 5 Post-test.......             166              39           19.26             751
Health Plan Choice Experiment:
    Pretest.....................................           1,000              83           19.26           1,599
    Experimental Web site.......................           1,000             167           19.26           3,216
    Baseline/Control Post-test..................             170              20           19.26             385
    Experimental Arm 1 Post-test.......             166              22           19.26             424
    Experimental Arm 2 Post-test.......             166              22           19.26             424
    Experimental Arm 3 Post-test.......             166              33           19.26             636
    Experimental Arm 4 Post-test.......             166              33           19.26             636
    Experimental Arm 5 Post-test.......             166              39           19.26             751
                                                 ---------------------------------------------------------------
        Total...................................           6,000             838              na         16,142
----------------------------------------------------------------------------------------------------------------
*Based upon the mean of the average wages, National Compensation Survey: Occupational wages in the United States
  2006, ``U.S. Department of Labor, Bureau of Labor Statistics.''

Estimated Annual Costs to the Federal Government

    The total cost to the Federal Government for developing and 
conducting both the health plan and clinician choice components of this 
study is $844,000, including the cost of designing the experiments, 
developing the simulated Web-based reports, conducting usability 
testing of the Web-reports, pilot testing the experiment, collecting 
the data, analyzing the data, preparing reports and papers for journal 
submission, and the cost for AHRQ staff

[[Page 51487]]

to oversee the project; see Exhibit 3. The annualized cost for this two 
year project is $422,000.

                   Exhibit 3--Project Cost Components
------------------------------------------------------------------------
                                                                 Cost
                       Cost components                         estimate
------------------------------------------------------------------------
Experimental design.........................................    $168,900
Development of simulated Web-based reports..................     157,900
Pilot testing...............................................      56,000
Usability testing of Web-based reports......................      56,300
Data collection via Knowledge Networks......................     126,000
Data analysis...............................................      56,300
Preparation of reports and journal papers...................     112,600
    AHRQ project management.................................     110,000
                                                             -----------
    Total...................................................     844,000
------------------------------------------------------------------------

Request for Comments

    In accordance with the above-cited Paperwork Reduction Act 
legislation, comments on AHRQ's information collection are requested 
with regard to any of the following: (a) Whether the proposed 
collection of information is necessary for the proper performance of 
AHRQ health care research and health care information dissemination 
functions, including whether the information will have practical 
utility; (b) the accuracy of AHRQ's estimate of burden (including hours 
and costs) of the proposed collection(s) of information; (c) ways to 
enhance the quality, utility, and clarity of the information to be 
collected; and (d) ways to minimize the burden of the collection of 
information upon the respondents, including the use of automated 
collection techniques or other forms of information technology.
    Comments submitted in response to this notice will be summarized 
and included in the Agency's subsequent request for OMB approval of the 
proposed information collection. All comments will become a matter of 
public record.

    Dated: August 26, 2008.
Carolyn M. Clancy,
Director.
[FR Doc. E8-20315 Filed 9-2-08; 8:45 am]
BILLING CODE 4160-90-M