Agency Information Collection Activities: Proposed Collection; Comment Request, 51484-51487 [E8-20315]
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Federal Register / Vol. 73, No. 171 / Wednesday, September 3, 2008 / Notices
A under ‘‘CERHR Reports &
Monographs’’ or directly at https://
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 (https://
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
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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.
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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)
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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
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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
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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.
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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
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*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
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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,
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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
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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
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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
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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 https://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: https://
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:
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]]>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]
-----------------------------------------------------------------------
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
