Agency Information Collection Activities: Proposed Collection; Comment Request, 16129-16132 [2010-6776]
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Federal Register / Vol. 75, No. 61 / Wednesday, March 31, 2010 / Notices
Dated: March 22, 2010.
Maryam I. Daneshvar,
Acting Reports Clearance Officer, Centers for
Disease Control and Prevention.
[FR Doc. 2010–7171 Filed 3–30–10; 8:45 am]
BILLING CODE 4163–18–P
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:
‘‘Studying the Implementation of a
Chronic Care Toolkit and Practice
Coaching In Practices Serving
Vulnerable Populations.’’ In accordance
with the Paperwork Reduction Act, 44
U.S.C. 3501–3520, AHRQ invites the
public to comment on this proposed
information collection.
This proposed information collection
was previously published in the Federal
Register on February 1, 2010 and
allowed 60 days for public comment.
One comment was received. The
purpose of this notice is to allow an
additional 30 days for public comment.
DATES: Comments on this notice must be
received by April 30, 2010.
Written comments should
be submitted to: AHRQ’s OMB Desk
Officer by fax at (202) 395–6974
(attention: AHRQ’s desk officer) or by email at OIRA_submission@omb.eop.gov
(attention: AHRQ’s desk officer).
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.
jlentini on DSKJ8SOYB1PROD with NOTICES
ADDRESSES:
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:
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Proposed Project
Studying the Implementation of a
Chronic Care Toolkit and Practice
Coaching In Practices Serving
Vulnerable Populations
An important part of AHRQ’s mission
is to disseminate information and tools
that can support improvement in quality
and safety in the U.S. health care
community. This proposed information
collection supports that part of AHRQ’s
mission by further refining the practice
coaching delivered in conjunction with
a previously developed toolkit,
Implementing Integrating Chronic Care
and Business Strategies in the Safety
Net: A Toolkit for Primary Care
Practices and Clinics. AHRQ requests
that the Office of Management and
Budget approve, under the Paperwork
Reduction Act of 1995, AHRQ’s
intention to collect information needed
to determine whether practice coaching
is effective in facilitating adoption of the
Chronic Care Model (CCM) for
improving treatment and management
of chronic medical conditions by
primary care physicians, especially
those who care for underserved
populations. This project is being
conducted pursuant to AHRQ’s
statutory authority to conduct and
support research on health care and on
systems for the delivery of such care,
including activities with respect to
quality measurement and improvement
and with respect to clinical practice,
including primary care and practiceoriented research. 42 U.S.C. 299a(a)(2)
and (4). This project will be conducted
by AHRQ through a contract with the
University of Minnesota.
Although 1,500 physician practices in
the U.S. and internationally have been
involved in CCM quality improvement
efforts, most patients still do not receive
their chronic care in accordance with
CCM. One factor affecting CCM
implementation has been that having
teams attend collaborative meetings
(three two-day meetings over a ninemonth period) is burdensome,
especially for under-resourced
providers. An attempt to use the
Internet as a virtual collaborative met
with disappointing results. Another
barrier to adoption of the CCM in
settings that serve vulnerable
populations is the scarcity of resources
to implement and sustain the CCM. In
2006 AHRQ contracted with the RAND
Corporation, Group Health’s MacColl
Institute, and the California Health Care
Safety Net Institute (SNI) to develop a
toolkit that informs safety net providers
on how to redesign their systems of care
along the lines of the Chronic Care
Model while attending to their financial
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16129
realities. The result was Implementing
Integrating Chronic Care and Business
Strategies in the Safety Net: A Toolkit
for Primary Care Practices and Clinics.
The Toolkit was piloted in two
California safety net clinics.
Recognizing that merely distributing the
Toolkit was unlikely to foster adoption
of CCM, the intervention included six
months of practice coaching delivered
by the MacColl Institute. Practice
Coaches (PC) are health care or related
professionals who help primary care
practices in a variety of quality
improvement and research activities.
PCs made two site visits to each site and
participated in weekly team meetings by
phone. They also interacted with the
sites through e-mail and phone contact.
The lack of documentation available
on coaching led to the development of
a practice coaching manual, which was
funded by AHRQ through a contract
with the RAND Corporation.
Development of the Coaching Manual
entailed conducting a literature review,
interviewing practice coaching experts,
and incorporating evaluation results
from the coaching provided in
conjunction with the Toolkit. The
Coaching Manual was published in the
winter of 2009. The literature review
and interviews revealed that there are a
number of different models of practice
coaching. However, knowledge is scant
about how practice coaching is best
performed, under what conditions
practice coaching is most successful,
and the costs of coaching and being
coached. Pilot testing the Toolkit with a
low-intensity practice coaching strategy
proved insufficient to encourage
practices to use the Toolkit
independently. The Toolkit was
subsequently streamlined based on pilot
sites’ reports that the initial Toolkit was
not easy to use. This project will explore
the implementation of the revised
Toolkit along with a more intensive
practice coaching strategy, providing
lessons on methods to improve chronic
care in clinical practices that serve
vulnerable populations.
Method of Collection
This project will include the
following data collections:
(1) Key Informant Interviews with
providers, staff and practice coaches
from 20 safety net practices that
participate in the practice coaching
intervention. These will be used to
describe the process and content of
practice coaching, perceived changes
from the coaching intervention at the
practice, provider and patient levels,
factors that impeded or facilitated the
coaching intervention and
implementation of practice changes
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Federal Register / Vol. 75, No. 61 / Wednesday, March 31, 2010 / Notices
through the coaching process, overall
satisfaction with practice coaching, and
recommendations for improvement.
(2) Primary Care Practice Profile
(PCPP). This questionnaire will be
completed by a single individual at each
site, either the medical director or chief
administrator, and will provide an
overview of each replication site that
will help place intervention activities
and outcomes in context for each site.
It covers demographics of patients
served, patient flow, disease health
outcomes, most frequent diagnoses,
most frequent referrals, number of staff
by discipline, staff and patient
satisfaction, processes of care, and
organizational processes.
(3) Physician Practice ConnectionsReadiness Survey (PPC–RS)—This
questionnaire asks about the presence of
53 practice systems in 5 of the 6
domains of the Chronic Care Model:
Clinical information systems
(information systems, presence of
registry or organized database, and
systematic monitoring of patient
population); decision support (clinician
reminders and alerts for lab tests, and
visits or guidelines related to individual
patient care), delivery system redesign
(services for managing patients with
chronic illness involving multiple
clinicians and care between visits),
health care organization (performance
tracking and feedback, process of using
clinical information systems to
aggregate and report on key indicators,
and use of data for benchmarking
performance and informing QI
activities), and clinical quality
improvement (presence of formal
processes to assess care, develop
interventions, and use data to monitor
the effects).
(4) Assessment of Chronic Illness Care
(ACIC)—The ACIC is contained in the
Toolkit and yields subscale scores and
a total score. Subscale scores reflect
CCM components and include:
Community linkages, self-management
support, decision support, delivery
system design, information systems, and
organization of care.
(5) Change Process Capability
Questionnaire (CPCQ)—The CPCQ
assesses 30 factors and strategies that
experienced quality improvement
leaders ranked as most important for
successful implementation. A recent
validation study found good predictive
validity. Items correlating with the PPC–
RS were eliminated after the initial
validation study so there is little to no
overlap across the two measures. In
addition to changes in the content of
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care (CCM components), these also
include organizational will for change
(Priority) and capacity and skill in the
conduct of the actual change processes
and strategies.
(6) Patient Assessment of Chronic
Illness Care (PACIC)—The 20-item
PACIC consists of five subscales which
assess components of the CCM: Patient
activation, delivery system design/
decision support, goal setting, problemsolving/contextual counseling, and
followup and coordination.
(7) Consumer Assessment of
Healthcare Providers and Systems—
Primary Care Adult—This questionnaire
assesses patient experiences in three
areas: Getting appointments and
healthcare when needed; how well
doctors communicate, and courteous
and helpful office staff.
(8) Primary Care Staff Satisfaction
Survey—This questionnaire assesses
staff satisfaction with their work
environment. It consists of 8 4-point
likert scale items and 2 open-ended
questions, and was developed by the
Institute for Healthcare Improvement.
(9) Chart Audits—Chart audits will be
conducted at baseline, the end of the 10month coaching intervention, and at 3month follow-up to assess changes in
patient care quality over the course of
the intervention. A chart abstraction
form will be developed to collect these
data. This data collection will be
performed by the project staff and will
not impose a burden on the
participating sites. Therefore, OMB
clearance is not required for this data
collection.
Clinic staff will be provided with a
paper version of the surveys as well as
the option to complete the surveys on
line using a secure on-line survey
program. With the exception of the staff
surveys, no special information
technology will be used to collect
information, since many of the data
collection forms are standardized
instruments available in hard-copy
form, and special permission from the
developers would be required to create
electronic versions of these forms. The
information collection is a one-time
only project; thus, there would be little
benefit in reduced burden from
automated information collection tools
for the other instruments.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated
annualized burden hours for the
respondents’ time to participate in this
two-year study. Key informant
interviews will be conducted with
practice coaches at midpoint in the
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intervention and again at the end of the
intervention. Key informant interviews
will also be conducted with up to 3
primary care providers and 2 other staff
members from each of the 20 practices
(10 per year) prior to start of the
intervention, and again at 3-month
follow-up after the intervention is
completed. Each interview takes about 1
hour.
The Primary Care Practice Profile will
be administered once and will be
completed by one staff person from each
practice and takes 30 minutes to
complete. The Physician Practice
Connections-Readiness Survey (PPC–
RS) will be completed pre, post and at
3-month follow-up by three individuals
from each of the 20 practices
(individuals with the appropriate
knowledge to complete the survey will
be identified by the medical director of
each site). It takes 90 minutes to
complete. The Assessment of Chronic
Illness Care (ACIC) will be completed by
4 staff and 4 primary care providers per
practice at pre, post and 3-month
follow-up and takes 30 minutes to
complete. The Change Process
Capability Questionnaire (CPCQ) will be
completed by 4 staff and 4 primary care
providers per practice at pre, post and
3-month follow-up and takes 15 minutes
to complete. The Primary Care Staff
Satisfaction Survey (PCSSS) will be
completed by 4 staff and 4 primary care
providers per practice at pre, post and
3-month follow-up and takes 15 minutes
to complete. The Patient Assessment of
Chronic Illness Care (PACIC) will be
completed by 3,000 adult patients
(1,500 annually) with chronic illness
and requires 15 minutes to complete.
The Consumer Assessment of
Healthcare Providers and Systems—
Primary Care Adult (CAHPS) will be
completed by 3,000 adult patients
(1,500 annually) with chronic illness
and requires 45 minutes to complete.
Both patient surveys will be
administered to adult patients with a
chronic disease who receive care at the
practices during a 2-day data collection
period immediately before, immediately
after, and at 3-month follow-up. The
surveys will be administered during the
post visit period in the wait room, by a
bi-lingual Spanish-English research
assistant. The total annualized burden
hours are estimated to be 1,984 hours.
Exhibit 2 shows the estimated
annualized cost burden associated with
the respondent’s time to participate in
this study. The total annualized cost
burden is estimated to be $60,714.
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EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS
Number of
respondents
Form name
Key informant interviews with practice coaches ..............................................
Key informant interviews with providers (3 per practice interviewed twice) ...
Key informant interviews with staff (2 per practice interviewed twice) ...........
Primary Care Practice Profile (PCPP) .............................................................
Physician Practice Connections—Readiness Survey (PPC–RS) (3 per practice × 3 times) ...............................................................................................
Assessment of Chronic Illness Care (ACIC) (8 per practice × 3 times) .........
Change Process Capability Questionnaire (CPCQ) (8 per practice × 3
times) ............................................................................................................
Primary Care Staff Satisfaction Survey (PCSSS) (8 per practice 3 × times)
Patient Assessment of Chronic Illness Care (PACIC) ....................................
Consumer Assessment of Healthcare Providers and Systems—Primary
Care Adult (CAHPS) ....................................................................................
Total ..........................................................................................................
Number of responses per
respondent
Hours per
response
Total burden
hours
2
10
10
10
2
6
4
1
1
1
1
30/60
4
60
40
5
10
10
9
24
1.5
30/60
135
120
10
10
1,500
24
24
1
15/60
15/60
15/60
60
60
375
1,500
1
45/60
1,125
3,072
na
na
1,984
EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN
Number of
respondents
Form name
Total burden
hours
Average hourly wage rate *
Total cost
burden
Key informant interviews with practice coaches ..............................................
Key informant interviews with providers ..........................................................
Key informant interviews with staff ..................................................................
Primary Care Practice Profile (PCPP) .............................................................
Physician Practice Connections—Readiness Survey (PPC–RS) ...................
Assessment of Chronic Illness Care (ACIC) ...................................................
Change Process Capability Questionnaire (CPCQ) ........................................
Primary Care Staff Satisfaction Survey ...........................................................
Patient Assessment of Chronic Illness Care (PACIC) ....................................
Consumer Assessment of Healthcare Providers and Systems—Primary
Care Adult (CAHPS) ....................................................................................
2
10
10
10
10
10
10
10
1,500
4
60
40
5
135
120
60
60
375
$42.00
77.64
32.64
77.64
77.64
** 55.14
** 55.14
** 55.14
20.32
$168
4,658
1,306
388
10,481
6,617
3,308
3,308
7,620
1,500
1,125
20.32
22.860
Total ..........................................................................................................
3,072
1,984
na
60,714
* Based upon the mean of the average wages, May 2008 National Occupational and Wage Estimates accessed on December 14, 2009 at:
https://www.bls.gov/oes/current/oes_nat.htm#b29–0000.
National Compensation Survey:
** Average for 4 staff ($32.64/hr) and 4 physician clinicians ($77.64/hr).
Estimated Annual Costs to the Federal
Government
research. The total cost over two years
is estimated to be $600,000.
Exhibit 3 shows the estimated total
and annualized cost to conduct this
EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST
Cost component
Total cost
Annualized cost
$162,744
92,994
92,994
23,248
92,994
135,026
$81,372
46,497
46,497
11,624
46,497
67,513
Total ......................................................................................................................................................
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Project Development ...................................................................................................................................
Data Collection Activities .............................................................................................................................
Data Processing and Analysis (20%) ..........................................................................................................
Publication of Results ..................................................................................................................................
Project Management ....................................................................................................................................
Overhead .....................................................................................................................................................
600,000
300,000
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
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necessary for the proper performance of
AHRQ healthcare research and
healthcare 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
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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
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Federal Register / Vol. 75, No. 61 / Wednesday, March 31, 2010 / Notices
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: March 19, 2010.
Carolyn M. Clancy,
Director.
[FR Doc. 2010–6776 Filed 3–30–10; 8:45 am]
BILLING CODE 4160–90–M
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:
‘‘Reductions of Infection Caused by
Carbapenem Resistant
Enterobacteriaceae (KPC) Producing
Organisms through the Application of
Recently Developed CDC/HICPAC
Recommendations.’’ In accordance with
the Paperwork Reduction Act, 44 U.S.C.
3501–3520, AHRQ invites the public to
comment on this proposed information
collection.
DATES: Comments on this notice must be
received by June 1, 2010.
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.
jlentini on DSKJ8SOYB1PROD with NOTICES
ADDRESSES:
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:
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19:40 Mar 30, 2010
Jkt 220001
Proposed Project
Reductions of Infection Caused by
Carbapenem Resistant
Enterobacteriaceae (KPC) Producing
Organisms Through the Application of
Recently Developed CDC/HICPAC
Recommendations
Healthcare Acquired Infections (HAIs)
caused almost 100,000 deaths among
the 2.1 million people who acquired
infections while hospitalized in 2000,
and HAI rates have risen relentlessly
since then. On March 20, 2009, the
Centers for Disease Control (CDC) and
the Healthcare Infections Control
Practices Advisory Committee (HICPAC)
developed infection control (IC)
guidance for Klebsiella pneumonia
carbapenemase-producing (KPC)
isolates, as they have been rapidly
emerging as a significant challenge in
healthcare settings. The danger of these
bacteria is that they are resistant to
carbapenem (a class of beta-lactam
antibiotics with a broad spectrum of
antibacterial activity) and cannot be
treated by the most commonly
prescribed antibiotics. Limited
treatment options mean that infections
caused by carbapenem resistant bacteria
result in substantial mortality and
morbidity.
The CDC and HICPAC
recommendations draw on infection
control strategies which have been
applied to these pathogens in other
settings, and other evidence based
strategies in infection control. There has
been little research, however, on the
implementation of control strategies to
prevent the spread of these KPC
infections. The goal of this project is to
understand how these recommendations
can best be implemented and how
effective these recommendations will be
in practice. This research will advance
private and public efforts to improve
health care quality by improving
measures to control the spread of a
dangerous organism. This research will
also provide data for the development of
an implementation toolkit that hospitals
can use to prevent the spread of
carbapenem resistant bacteria. The
toolkit may include the following types
of resources: General information about
the implementation of evidenced-based
clinical practices, resource materials,
and tools and methods that users can
adopt to conduct point prevalence
surveys, protocols and tools that users
can adopt to specify when active KPC
surveillance is needed, and resources
for approaching the problem as a teambased quality-improvement effort.
OMB clearance will be sought for this
toolkit once it is developed.
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This study is being conducted by
AHRQ through its contractor, Boston
University, pursuant to AHRQ’s
statutory authority to conduct and
support research on healthcare and on
systems for the delivery of such care,
including activities with respect to the
quality, effectiveness, efficiency,
appropriateness and value of healthcare
services and with respect to quality
measurement and improvement. 42
U.S.C. 299a(a)(1) and (2).
Method of Collection
This project will include the
following data collections from the
intensive care unit (ICU) staff within
each of three participating hospitals:
(1) Pre-intervention focus groups will
be conducted separately with managers
and staff. The purpose of these focus
groups is to identify potential problems
in the implementation that can be
addressed through various means (e.g.,
additional education, other changes in
process). Another purpose is to
understand the existing approach to
quality improvement, the connection(s)
between overall approach to quality
improvement and to KPC infection
control practices, current practices at
the hospital of quality reporting and
accountability, and constraints and
obstacles to quality improvement as
seen in their roles. Staff members
identified for the focus groups will be
those with the most first-hand
knowledge of existing quality
improvement efforts, and KPC infection
control practices.
(2) Clinical staff survey. Factors
identified in the pre-intervention focus
groups will be used to inform the
development of a self-administered
survey of staff knowledge of and
attitudes toward KPC surveillance and
infection control procedures.
Respondents will be health care workers
on the units where these new guidelines
have been implemented. Findings from
the survey will be used to assess barriers
perceived by the staff, potential
differences across units, and potential
differences by employee/occupational
group.
(3) Post-intervention focus groups (6
months after implementation of new
KPC IC guidelines) will be conducted
separately with managers and staff. The
purpose of these focus groups is to
identify actual problems experienced in
the initial implementation and possible
measures to address, and to identify
successful practices to include in a
toolkit that hospitals can use to
implement the CDC and HICPAC
recommendations.
In addition to developing a toolkit,
AHRQ plans to disseminate the lessons
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]]>Agencies
[Federal Register Volume 75, Number 61 (Wednesday, March 31, 2010)]
[Notices]
[Pages 16129-16132]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-6776]
-----------------------------------------------------------------------
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: ``Studying the Implementation of a Chronic Care Toolkit and
Practice Coaching In Practices Serving Vulnerable Populations.'' In
accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-3520, AHRQ
invites the public to comment on this proposed information collection.
This proposed information collection was previously published in
the Federal Register on February 1, 2010 and allowed 60 days for public
comment. One comment was received. The purpose of this notice is to
allow an additional 30 days for public comment.
DATES: Comments on this notice must be received by April 30, 2010.
ADDRESSES: Written comments should be submitted to: AHRQ's OMB Desk
Officer by fax at (202) 395-6974 (attention: AHRQ's desk officer) or by
e-mail at OIRA_submission@omb.eop.gov (attention: AHRQ's desk
officer).
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
Studying the Implementation of a Chronic Care Toolkit and Practice
Coaching In Practices Serving Vulnerable Populations
An important part of AHRQ's mission is to disseminate information
and tools that can support improvement in quality and safety in the
U.S. health care community. This proposed information collection
supports that part of AHRQ's mission by further refining the practice
coaching delivered in conjunction with a previously developed toolkit,
Implementing Integrating Chronic Care and Business Strategies in the
Safety Net: A Toolkit for Primary Care Practices and Clinics. AHRQ
requests that the Office of Management and Budget approve, under the
Paperwork Reduction Act of 1995, AHRQ's intention to collect
information needed to determine whether practice coaching is effective
in facilitating adoption of the Chronic Care Model (CCM) for improving
treatment and management of chronic medical conditions by primary care
physicians, especially those who care for underserved populations. This
project is being conducted pursuant to AHRQ's statutory authority to
conduct and support research on health care and on systems for the
delivery of such care, including activities with respect to quality
measurement and improvement and with respect to clinical practice,
including primary care and practice-oriented research. 42 U.S.C.
299a(a)(2) and (4). This project will be conducted by AHRQ through a
contract with the University of Minnesota.
Although 1,500 physician practices in the U.S. and internationally
have been involved in CCM quality improvement efforts, most patients
still do not receive their chronic care in accordance with CCM. One
factor affecting CCM implementation has been that having teams attend
collaborative meetings (three two-day meetings over a nine-month
period) is burdensome, especially for under-resourced providers. An
attempt to use the Internet as a virtual collaborative met with
disappointing results. Another barrier to adoption of the CCM in
settings that serve vulnerable populations is the scarcity of resources
to implement and sustain the CCM. In 2006 AHRQ contracted with the RAND
Corporation, Group Health's MacColl Institute, and the California
Health Care Safety Net Institute (SNI) to develop a toolkit that
informs safety net providers on how to redesign their systems of care
along the lines of the Chronic Care Model while attending to their
financial realities. The result was Implementing Integrating Chronic
Care and Business Strategies in the Safety Net: A Toolkit for Primary
Care Practices and Clinics. The Toolkit was piloted in two California
safety net clinics. Recognizing that merely distributing the Toolkit
was unlikely to foster adoption of CCM, the intervention included six
months of practice coaching delivered by the MacColl Institute.
Practice Coaches (PC) are health care or related professionals who help
primary care practices in a variety of quality improvement and research
activities. PCs made two site visits to each site and participated in
weekly team meetings by phone. They also interacted with the sites
through e-mail and phone contact.
The lack of documentation available on coaching led to the
development of a practice coaching manual, which was funded by AHRQ
through a contract with the RAND Corporation. Development of the
Coaching Manual entailed conducting a literature review, interviewing
practice coaching experts, and incorporating evaluation results from
the coaching provided in conjunction with the Toolkit. The Coaching
Manual was published in the winter of 2009. The literature review and
interviews revealed that there are a number of different models of
practice coaching. However, knowledge is scant about how practice
coaching is best performed, under what conditions practice coaching is
most successful, and the costs of coaching and being coached. Pilot
testing the Toolkit with a low-intensity practice coaching strategy
proved insufficient to encourage practices to use the Toolkit
independently. The Toolkit was subsequently streamlined based on pilot
sites' reports that the initial Toolkit was not easy to use. This
project will explore the implementation of the revised Toolkit along
with a more intensive practice coaching strategy, providing lessons on
methods to improve chronic care in clinical practices that serve
vulnerable populations.
Method of Collection
This project will include the following data collections:
(1) Key Informant Interviews with providers, staff and practice
coaches from 20 safety net practices that participate in the practice
coaching intervention. These will be used to describe the process and
content of practice coaching, perceived changes from the coaching
intervention at the practice, provider and patient levels, factors that
impeded or facilitated the coaching intervention and implementation of
practice changes
[[Page 16130]]
through the coaching process, overall satisfaction with practice
coaching, and recommendations for improvement.
(2) Primary Care Practice Profile (PCPP). This questionnaire will
be completed by a single individual at each site, either the medical
director or chief administrator, and will provide an overview of each
replication site that will help place intervention activities and
outcomes in context for each site. It covers demographics of patients
served, patient flow, disease health outcomes, most frequent diagnoses,
most frequent referrals, number of staff by discipline, staff and
patient satisfaction, processes of care, and organizational processes.
(3) Physician Practice Connections-Readiness Survey (PPC-RS)--This
questionnaire asks about the presence of 53 practice systems in 5 of
the 6 domains of the Chronic Care Model: Clinical information systems
(information systems, presence of registry or organized database, and
systematic monitoring of patient population); decision support
(clinician reminders and alerts for lab tests, and visits or guidelines
related to individual patient care), delivery system redesign (services
for managing patients with chronic illness involving multiple
clinicians and care between visits), health care organization
(performance tracking and feedback, process of using clinical
information systems to aggregate and report on key indicators, and use
of data for benchmarking performance and informing QI activities), and
clinical quality improvement (presence of formal processes to assess
care, develop interventions, and use data to monitor the effects).
(4) Assessment of Chronic Illness Care (ACIC)--The ACIC is
contained in the Toolkit and yields subscale scores and a total score.
Subscale scores reflect CCM components and include: Community linkages,
self-management support, decision support, delivery system design,
information systems, and organization of care.
(5) Change Process Capability Questionnaire (CPCQ)--The CPCQ
assesses 30 factors and strategies that experienced quality improvement
leaders ranked as most important for successful implementation. A
recent validation study found good predictive validity. Items
correlating with the PPC-RS were eliminated after the initial
validation study so there is little to no overlap across the two
measures. In addition to changes in the content of care (CCM
components), these also include organizational will for change
(Priority) and capacity and skill in the conduct of the actual change
processes and strategies.
(6) Patient Assessment of Chronic Illness Care (PACIC)--The 20-item
PACIC consists of five subscales which assess components of the CCM:
Patient activation, delivery system design/decision support, goal
setting, problem-solving/contextual counseling, and followup and
coordination.
(7) Consumer Assessment of Healthcare Providers and Systems--
Primary Care Adult--This questionnaire assesses patient experiences in
three areas: Getting appointments and healthcare when needed; how well
doctors communicate, and courteous and helpful office staff.
(8) Primary Care Staff Satisfaction Survey--This questionnaire
assesses staff satisfaction with their work environment. It consists of
8 4-point likert scale items and 2 open-ended questions, and was
developed by the Institute for Healthcare Improvement.
(9) Chart Audits--Chart audits will be conducted at baseline, the
end of the 10-month coaching intervention, and at 3-month follow-up to
assess changes in patient care quality over the course of the
intervention. A chart abstraction form will be developed to collect
these data. This data collection will be performed by the project staff
and will not impose a burden on the participating sites. Therefore, OMB
clearance is not required for this data collection.
Clinic staff will be provided with a paper version of the surveys
as well as the option to complete the surveys on line using a secure
on-line survey program. With the exception of the staff surveys, no
special information technology will be used to collect information,
since many of the data collection forms are standardized instruments
available in hard-copy form, and special permission from the developers
would be required to create electronic versions of these forms. The
information collection is a one-time only project; thus, there would be
little benefit in reduced burden from automated information collection
tools for the other instruments.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
respondents' time to participate in this two-year study. Key informant
interviews will be conducted with practice coaches at midpoint in the
intervention and again at the end of the intervention. Key informant
interviews will also be conducted with up to 3 primary care providers
and 2 other staff members from each of the 20 practices (10 per year)
prior to start of the intervention, and again at 3-month follow-up
after the intervention is completed. Each interview takes about 1 hour.
The Primary Care Practice Profile will be administered once and
will be completed by one staff person from each practice and takes 30
minutes to complete. The Physician Practice Connections-Readiness
Survey (PPC-RS) will be completed pre, post and at 3-month follow-up by
three individuals from each of the 20 practices (individuals with the
appropriate knowledge to complete the survey will be identified by the
medical director of each site). It takes 90 minutes to complete. The
Assessment of Chronic Illness Care (ACIC) will be completed by 4 staff
and 4 primary care providers per practice at pre, post and 3-month
follow-up and takes 30 minutes to complete. The Change Process
Capability Questionnaire (CPCQ) will be completed by 4 staff and 4
primary care providers per practice at pre, post and 3-month follow-up
and takes 15 minutes to complete. The Primary Care Staff Satisfaction
Survey (PCSSS) will be completed by 4 staff and 4 primary care
providers per practice at pre, post and 3-month follow-up and takes 15
minutes to complete. The Patient Assessment of Chronic Illness Care
(PACIC) will be completed by 3,000 adult patients (1,500 annually) with
chronic illness and requires 15 minutes to complete. The Consumer
Assessment of Healthcare Providers and Systems--Primary Care Adult
(CAHPS) will be completed by 3,000 adult patients (1,500 annually) with
chronic illness and requires 45 minutes to complete. Both patient
surveys will be administered to adult patients with a chronic disease
who receive care at the practices during a 2-day data collection period
immediately before, immediately after, and at 3-month follow-up. The
surveys will be administered during the post visit period in the wait
room, by a bi-lingual Spanish-English research assistant. The total
annualized burden hours are estimated to be 1,984 hours.
Exhibit 2 shows the estimated annualized cost burden associated
with the respondent's time to participate in this study. The total
annualized cost burden is estimated to be $60,714.
[[Page 16131]]
Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
Number of
Form name Number of responses per Hours per Total burden
respondents respondent response hours
----------------------------------------------------------------------------------------------------------------
Key informant interviews with practice coaches.. 2 2 1 4
Key informant interviews with providers (3 per 10 6 1 60
practice interviewed twice)....................
Key informant interviews with staff (2 per 10 4 1 40
practice interviewed twice)....................
Primary Care Practice Profile (PCPP)............ 10 1 30/60 5
Physician Practice Connections--Readiness Survey 10 9 1.5 135
(PPC-RS) (3 per practice x 3 times)............
Assessment of Chronic Illness Care (ACIC) (8 per 10 24 30/60 120
practice x 3 times)............................
Change Process Capability Questionnaire (CPCQ) 10 24 15/60 60
(8 per practice x 3 times).....................
Primary Care Staff Satisfaction Survey (PCSSS) 10 24 15/60 60
(8 per practice 3 x times).....................
Patient Assessment of Chronic Illness Care 1,500 1 15/60 375
(PACIC)........................................
Consumer Assessment of Healthcare Providers and 1,500 1 45/60 1,125
Systems--Primary Care Adult (CAHPS)............
---------------------------------------------------------------
Total....................................... 3,072 na na 1,984
----------------------------------------------------------------------------------------------------------------
Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
Number of Total burden Average hourly Total cost
Form name respondents hours wage rate * burden
----------------------------------------------------------------------------------------------------------------
Key informant interviews with practice coaches.. 2 4 $42.00 $168
Key informant interviews with providers......... 10 60 77.64 4,658
Key informant interviews with staff............. 10 40 32.64 1,306
Primary Care Practice Profile (PCPP)............ 10 5 77.64 388
Physician Practice Connections--Readiness Survey 10 135 77.64 10,481
(PPC-RS).......................................
Assessment of Chronic Illness Care (ACIC)....... 10 120 ** 55.14 6,617
Change Process Capability Questionnaire (CPCQ).. 10 60 ** 55.14 3,308
Primary Care Staff Satisfaction Survey.......... 10 60 ** 55.14 3,308
Patient Assessment of Chronic Illness Care 1,500 375 20.32 7,620
(PACIC)........................................
Consumer Assessment of Healthcare Providers and 1,500 1,125 20.32 22.860
Systems--Primary Care Adult (CAHPS)............
---------------------------------------------------------------
Total....................................... 3,072 1,984 na 60,714
----------------------------------------------------------------------------------------------------------------
* Based upon the mean of the average wages, May 2008 National Occupational and Wage Estimates accessed on
December 14, 2009 at: https://www.bls.gov/oes/current/oes_nat.htm#b29-0000.
National Compensation Survey:
** Average for 4 staff ($32.64/hr) and 4 physician clinicians ($77.64/hr).
Estimated Annual Costs to the Federal Government
Exhibit 3 shows the estimated total and annualized cost to conduct
this research. The total cost over two years is estimated to be
$600,000.
Exhibit 3--Estimated Total and Annualized Cost
------------------------------------------------------------------------
Cost component Total cost Annualized cost
------------------------------------------------------------------------
Project Development............... $162,744 $81,372
Data Collection Activities........ 92,994 46,497
Data Processing and Analysis (20%) 92,994 46,497
Publication of Results............ 23,248 11,624
Project Management................ 92,994 46,497
Overhead.......................... 135,026 67,513
-------------------------------------
Total......................... 600,000 300,000
------------------------------------------------------------------------
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 healthcare research and healthcare 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
[[Page 16132]]
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: March 19, 2010.
Carolyn M. Clancy,
Director.
[FR Doc. 2010-6776 Filed 3-30-10; 8:45 am]
BILLING CODE 4160-90-M
