Agency Information Collection Activities: Proposed Collection; Comment Request, 29192-29195 [2014-11726]
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Federal Register / Vol. 79, No. 98 / Wednesday, May 21, 2014 / Notices
Method of Collection
To achieve the goals of this project,
AHRQ will train primary care practice
facilitators using the TeamSTEPPS in
Primary Care training curriculum.
Primary care practice facilitators may
voluntarily sign up for this free, AHRQ
sponsored training. Training will be
delivered through a combination of
online and in-person instruction. Online
training will cover the core
TeamSTEPPS tools and strategies that
can be implemented in primary care. Inperson instruction will cover coaching,
organizational change, and
implementation science. Practice
facilitators, who complete the training,
will be surveyed six months posttraining.
The TeamSTEPPS Primary Care PostTraining Survey is an online instrument
that will be administered to all primary
care practice facilitators who complete
the TeamSTEPPS in Primary Care
training. The survey will be
administered six months after
participants complete training.
This is a new data collection effort for
the purpose of conducting an evaluation
of TeamSTEPPS in Primary Care
Training. The evaluation is formative in
nature as AHRQ seeks information to
improve the content and delivery of the
training. Training will be provided
through a combination of online and inperson instruction.
To conduct the evaluation, the
TeamSTEPPS in Primary Care PostTraining Survey will be administered to
all individuals who complete the
TeamSTEPPS in Primary Care training
six months after training. The survey
assesses the degree to which
participants felt prepared by the training
and what they did to implement
TeamSTEPPS in primary care practices.
Specifically, participants will be asked
about their reasons for participating in
the program; the degree to which they
feel the training prepared them to train
others in and use TeamSTEPPS in the
primary care setting; what tools they
have implemented in primary care
practices; and resulting changes they
have observed in the delivery of care.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated
annualized burden hours for the
respondent’s time to participate in the
study. The TeamSTEPPS in Primary
Care Post-Training Survey will be
completed by approximately 150
individuals. We estimate that each
respondent will answer 20 items (i.e.,
number of responses per respondent)
and responding to these 20 questions
will require 20 minutes. The total
annualized burden is estimated to be 50
hours.
Exhibit 2 shows the estimated
annualized cost burden based on the
respondents’ time to participate in the
study. The total cost burden is estimated
to be $4,348.
EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS
Number of
respondents
Form name
Number of
responses per
respondent
Hours per
response
Total
burden hours
TeamSTEPPS in Primary Care Post-Training Survey ....................................
150
1
20/60
50
Total ..........................................................................................................
150
NA
NA
50
EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN
Number of
respondents
Form name
Total
burden hours
Average
hourly wage
rate *
Total cost
burden
TeamSTEPPS Primary Care Post-training Survey .........................................
150
50
a $86.95
$4,348
Total ..........................................................................................................
150
50
86.95
4,348
* National Compensation Survey: Occupational wages in the United States May 2012, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’
a Based on the mean wages for Family and General Practitioners 29–1062.
mstockstill on DSK4VPTVN1PROD with NOTICES
Request for Comments
In accordance with the Paperwork
Reduction Act, 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
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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: May 13, 2014.
Richard Kronick,
AHRQ Director.
BILLING CODE 4160–90–P
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Agency for Healthcare Research and
Quality
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Agency for Healthcare Research
and Quality, HHS.
AGENCY:
ACTION:
[FR Doc. 2014–11727 Filed 5–20–14; 8:45 am]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Sfmt 4703
Notice.
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: ‘‘Guide
to Nursing Home Antimicrobial
SUMMARY:
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Federal Register / Vol. 79, No. 98 / Wednesday, May 21, 2014 / Notices
Stewardship.’’ 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 July 21, 2014.
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
email at doris.lefkowitz@ahrq.hhs.gov.
SUPPLEMENTARY INFORMATION:
Proposed Project
mstockstill on DSK4VPTVN1PROD with NOTICES
Guide to Nursing Home Antimicrobial
Stewardship
This project seeks to contribute to
AHRQ’s mission by assisting nursing
homes to optimize antimicrobial (e.g.,
antibiotics and antifungals) prescribing
practices, also referred to as
antimicrobial stewardship.
Antimicrobial stewardship programs
reduce the development of drugresistant organisms, enhance patient
outcomes, and reduce unnecessary
costs.
Nursing homes serve as one of our
most fertile breeding grounds for
antibiotic-resistant strains of bacteria.
This stems from high rates of infection
in nursing home residents due to the
effects of normal aging combined with
multiple chronic diseases. The most
common infections encountered in
nursing home residents are pneumonia,
urinary tract infections, and skin and
soft tissue infections. In one study by
Yoshikawa and Norman, researchers
found that these three types of
infections accounted for approximately
75 percent of all nursing homeassociated infections (NHAIs) . High
rates of these infections lead to
antimicrobials being among the most
commonly prescribed pharmaceuticals
in long-term care settings. In nursing
homes, where polypharmacy is the rule
rather than the exception, as many as 40
percent of all prescriptions are for
antimicrobial agents, and depending on
the study, 25 percent to 75 percent have
been deemed inappropriately
prescribed. Such inappropriate
prescribing results in negative
outcomes, including adverse drug
events, hospital admissions, and higher
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17:42 May 20, 2014
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health care costs. Most significantly,
inappropriate antimicrobial prescribing
gives rise to the development of multidrug resistant organisms (MDROs),
including Methicillin-resistant
Staphylococcus aureus, Vancomycinresistant Enterococci, and
fluoroquinolone-resistant strains of a
variety of bacteria, and leads to the
development of Clostridium difficile
infections.
In general, determining
‘‘appropriateness’’ of antimicrobial use
in healthcare settings is challenging to
standardize. This becomes even more
complicated in the nursing home setting
because most antimicrobial courses are
started empirically (without results from
labs) due to the limited diagnostics
available to many nursing homes. In an
effort to address the need for optimizing
antibiotic use in the nursing homes,
AHRQ is testing a Guide to Nursing
Home Antimicrobial Stewardship (the
Guide). The Guide is intended to help
nursing home staff easily identify
toolkits that have been shown to be
effective in optimizing antimicrobial
use. There are multiple toolkits that
could be used by a nursing home, and
nursing homes face a potentially timeconsuming decision process to choose
the most appropriate one. The Guide is
intended to help nursing homes make
this choice efficiently and effectively.
The research has the following goals:
Develop a nursing home-specific
antimicrobial stewardship guide,
containing toolkits to assist nursing
homes to optimize antimicrobial
prescribing practices, monitor microbes
and antimicrobial use, enhance
communication between nursing home
staff and attending clinicians, and
enhance communication and
engagement with residents and family
members regarding optimizing
antimicrobial practices.
Evaluate the ability of nursing homes
to use the Guide and improve
antimicrobial use through better
stewardship.
Develop a plan to ensure wide
dissemination of the findings and
recommendations for antimicrobial
stewardship uptake in nursing homes.
This study is being conducted by
AHRQ through its contractor, American
Institutes for Research, 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).
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Method of Collection
To achieve the goals of this project the
following data collections will be
implemented:
(1) Medical Record Review (MRR).
The MRR will be used to obtain data
about antimicrobial prescribing
practices, infection prevalence, and
residents’ health and functional
statuses. These data will be used in the
evaluation of the Guide’s impact.
Members of the research team will
review the nursing home’s medical
charts, the Nursing Home Minimum
Data Set (MDS), and the nursing home’s
infection control log for an evaluation
period of at least 12 months (6 months
before and 6 months after the
introduction of the Guide). The MDS is
part of the federally mandated process
for clinical assessment of all residents in
Medicare and Medicaid certified
nursing homes. This process provides a
comprehensive assessment of each
resident’s functional capabilities and
helps nursing home staff identify health
problems. Care Area Assessments are
part of this process, and provide the
foundation upon which a resident’s
individual care plan is formulated. MDS
assessments are completed for all
residents in certified nursing homes,
regardless of source of payment for the
individual resident. AHRQ will support
data abstraction at all nursing homes.
(2) Cost Data Analysis. AHRQ will use
the number and type of antimicrobial
prescriptions and secondary estimates
of the unit cost of these prescriptions,
obtained from external sources, to
compute the marginal impact of the
Guide on the cost of antimicrobials for
nursing homes.
(3) Pre-intervention Interviews with
nursing home leaders. The purpose of
these interviews is to gain an
understanding of perceptions and
current activities regarding
antimicrobial stewardship and to assess
the likelihood that the Guide will be
used with a reasonable degree of fidelity
to the implementation plan. This will
involve both closed and open-ended
interviews with nursing home leaders
(administrator, director of nursing,
assistant director of nursing, and/or
medical director). The open ended
interviews will examine (1) how the
staff perceive antimicrobial
stewardship; (2) the amount of
experience the staff has in antimicrobial
stewardship and its processes for
handling the diagnosis and treatment of
infections; and (3) which toolkit or
toolkits are likely to be adopted and
why. This information will help us
identify interests by nursing homes and
potential barriers to adopting a toolkit
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Federal Register / Vol. 79, No. 98 / Wednesday, May 21, 2014 / Notices
from the Guide. This information also
will be used to develop dissemination
guidance. The closed ended interview
questions, will be comprised of the
Absorptive Capacity for Change survey,
which asks about (1) leadership culture;
(2) clinician culture; (3) presence of
certified medical directors; and (4) level
of antimicrobial surveillance. For the
Evaluation, two leadership staff at each
nursing home will be interviewed for a
total of 20 interviews prior to
implementing the intervention.
(4) Passive Technical Assistance (TA).
The purpose of collecting these data is
to obtain information on the types of TA
needed as they emerge during the 6month intervention period. This
information will be used to improve the
Guide. AHRQ projects 60 contacts from
nursing home staff involved in
implementing the Guide (10 sites, one
per month at each site during the 6month intervention period).
(5) Proactive TA discussions. The
purpose of collecting these data is to
obtain information on the facilitators,
challenges, and unintended
consequences of implementing a
particular tool or toolkit. These informal
discussions will be held at each nursing
home once a month during the 6-month
intervention phase. Staff will be asked
about what activities they are
conducting, changes to implementation,
any facilitators, any challenges, and
how they have addressed any
challenges. This information will be
used to improve the Guide. For the
Evaluation, two individuals from each
nursing home are projected to attend
each of the six conference calls for a
total of 20 individuals and a total of 120
contacts.
(6) Post-intervention interviews. The
purpose of these interviews is to
identify (1) facilitators and barriers to
implementation; (2) perceived impacts
of the Guide on the use of
antimicrobials within the nursing home;
(3) the nursing home’s views on the
business case for the Guide; and (4)
ways to improve the tools. At a
minimum two nursing home leaders
and two champions (if different from
leaders) will be interviewed. In
addition, depending on the tool or
toolkit selected, up to two prescribing
clinicians, two nurses, or two residents
or family members might be interviewed
after the 6-month intervention period is
completed. No more than six
individuals per nursing home will be
interviewed for a total of 60
interviewees. Interviews may take place
together.
The information described above will
be used to evaluate the Guide and, if
found to be effective, develop a widespread dissemination plan for the
Guide.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated
annualized burden hours for the
respondents’ time to participate in this
information collection.
EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS
Number of
respondents
Form name
Number of
responses per
respondent
Hours per
response
Total
burden hours
Passive TA Collection Protocol .......................................................................
General Review of the Guide ..........................................................................
Pre-intervention interview protocol ..................................................................
Proactive TA discussion protocol ....................................................................
Post-intervention interview protocols ...............................................................
20
20
20
20
60
3
1
1
6
1
20/60
2
1
30/60
1
20
40
20
60
60
Total ..........................................................................................................
140
na
na
200
EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN
Number of
respondents
Form name
Total burden
hours
Average
hourly wage
rate *
Total cost
burden
Passive TA Collection Protocol .......................................................................
General review of the Guide ...........................................................................
Pre-intervention interview protocol ..................................................................
Proactive TA discussion protocol ....................................................................
Post-intervention interview protocols ...............................................................
20
20
20
20
60
20
40
20
60
60
$30.34
30.34
30.34
30.34
30.34
$607
1,214
607
1,820
1,820
Total ..........................................................................................................
140
200
na
6,068
* National Compensation Survey: Occupational wages in the United States May 2013, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’
We used an average across the following types of staff: Nursing home registered nurses ($29.81) 29–1141, nursing home licensed practical/vocational nurses ($21.14) 29–2061, and nursing home administrator ($40.07) 11–9111. Our average was created by adding each of these three
and dividing by three for the average. Sources: https://www.bls.gov/oes/current/oes291141.htm and https://www.bls.gov/oes/current/oes292061.htm;
https://www.bls.gov/oes/current/oes119111.htm.
mstockstill on DSK4VPTVN1PROD with NOTICES
Request for Comments
In accordance with the Paperwork
Reduction Act, 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
VerDate Mar<15>2010
17:42 May 20, 2014
Jkt 232001
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
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Sfmt 4703
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.
E:\FR\FM\21MYN1.SGM
21MYN1
Federal Register / Vol. 79, No. 98 / Wednesday, May 21, 2014 / Notices
Dated: May 13, 2014.
Richard Kronick,
AHRQ Director.
Proposed Project
Total Worker Health for Small
Business—New—National Institute for
Occupational Safety and Health
(NIOSH), Centers for Disease Control
and Prevention (CDC).
[FR Doc. 2014–11726 Filed 5–20–14; 8:45 am]
BILLING CODE 4160–90–P
Background and Brief Description
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
[30Day–14–14GW]
mstockstill on DSK4VPTVN1PROD with NOTICES
Agency Forms Undergoing Paperwork
Reduction Act Review
The Centers for Disease Control and
Prevention (CDC) has submitted the
following information collection request
to the Office of Management and Budget
(OMB) for review and approval in
accordance with the Paperwork
Reduction Act of 1995. The notice for
the proposed information collection is
published to obtain comments from the
public and affected agencies.
Written comments and suggestions
from the public and affected agencies
concerning the proposed collection of
information are encouraged. Your
comments should address any of the
following: (a) Evaluate whether the
proposed collection of information is
necessary for the proper performance of
the functions of the agency, including
whether the information will have
practical utility; (b) Evaluate the
accuracy of the agencies estimate of the
burden of the proposed collection of
information, including the validity of
the methodology and assumptions used;
(c) Enhance the quality, utility, and
clarity of the information to be
collected; (d) Minimize the burden of
the collection of information on those
who are to respond, including through
the use of appropriate automated,
electronic, mechanical, or other
technological collection techniques or
other forms of information technology,
e.g., permitting electronic submission of
responses; and (e) Assess information
collection costs.
To request additional information on
the proposed project or to obtain a copy
of the information collection plan and
instruments, call (404) 639–7570 or
send an email to omb@cdc.gov. Written
comments and/or suggestions regarding
the items contained in this notice
should be directed to the Attention:
CDC Desk Officer, Office of Management
and Budget, Washington, DC 20503 or
by fax to (202) 395–5806. Written
comments should be received within 30
days of this notice.
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The mission of the National Institute
for Occupational Safety and Health
(NIOSH) is to promote safety and health
at work for all people through research
and prevention. In this capacity, NIOSH
will administer in-depth interviews
designed to assess perceptions and
opinions among small business owners
in the Cincinnati/Northern Kentucky
area regarding the Total Worker Health
concept. This information will guide the
development of a model for diffusion of
the Total Worker Health approach
among small businesses by community
organizations. Total Worker Health for
Small Business is a four-year field study
whose overall goal is to identify the
perceived costs and benefits of offering
integrated occupational safety and
health (OSH) and workplace wellness
services to employees among small
businesses (SBs), and to inform methods
that will successfully diffuse the use of
a Total Worker Health approach among
small businesses and the community
organizations that serve them. The data
gathered in this study regarding small
businesses’ specific training needs,
motivational factors, and preferred
information sources will be of
significant practical value when
designing and implementing future
interventions.
The proposed in-depth interviews
described here for which Office of
Management and Budget review and
approval is being requested are a critical
step toward the development of this
TWH diffusion model. Phase 1 of this
project included interview development
and revision. The primary goal of Phase
2 of this project is to gather keyinformant perceptions and opinions
among the target audience, small
business owners in the Cincinnati/
Northern Kentucky area. Data gathered
from in-depth interviews will guide the
development of efforts to diffuse the
Total Worker Health approach among
small businesses and the community
organizations which serve them.
About 90% of U.S. employer
organizations have fewer than 20
employees, and 62% have less than five.
Eighteen percent of all U.S. employees
work for businesses that have less than
20 employees. In addition, more than 21
million U.S. businesses have zero
employees, meaning that, although they
are not counted as employees, the
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29195
owner is also the worker. Workers in
smaller organizations endure a
disproportionate share of the burden of
occupational injuries, illnesses, and
fatalities.
There is no data available on the
prevalence of TWH programs in smaller
organizations. What is known about
smaller organizations is divided into
information about health protection and
health promotion activities. Smaller
organizations engage in fewer safety
activities than larger organizations. The
need for reaching this population with
effective, affordable, and culturally
appropriate training has been
documented in publications and is
increasingly becoming an institutional
priority at NIOSH. Given the numerous
obstacles which small business owners
face in effectively managing
occupational safety and health (e.g.,
financial and time constraints), there is
a need for identifying the most crucial
components of occupational safety and
health and health promotion training.
This interview will be administered to
a sample of approximately 60 owners of
small businesses with 5–49 employees
from the Cincinnati/Northern Kentucky
area. Each participant will be
administered the survey two times,
approximately one year apart to assess
for changes in perceptions regarding
health protection and health promotion
activities. The sample size is based on
recommendations related to qualitative
interview methods and the research
team’s prior experience.
Participants for this data collection
will be recruited with the assistance of
contractors who have successfully
performed similar tasks for NIOSH in
the past. Participants will be receive $50
as a token of appreciation for their time.
The interview questionnaire will be
administered verbally to participants in
English.
Once this study is complete, results
will be made available via various
means including print publications and
the agency internet site. The
information gathered by this project
could be used by OSHA, state health
department, occupational health
providers to determine guidelines for
the development of appropriate training
materials for small businesses. The
results of this project will benefit small
business workers by developing
recommendations for increasing the
effectiveness of occupational safety and
health outreach methods specifically
targeted to small businesses. Although
beyond the scope of this study, it is
expected that improved use of TWH
programs will lower rates of injuries and
fatalities for workers. The total burden
hours are 180.
E:\FR\FM\21MYN1.SGM
21MYN1
]]>Agencies
[Federal Register Volume 79, Number 98 (Wednesday, May 21, 2014)]
[Notices]
[Pages 29192-29195]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-11726]
-----------------------------------------------------------------------
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: ``Guide to Nursing Home Antimicrobial
[[Page 29193]]
Stewardship.'' 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 July 21, 2014.
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 email at
doris.lefkowitz@ahrq.hhs.gov.
SUPPLEMENTARY INFORMATION:
Proposed Project
Guide to Nursing Home Antimicrobial Stewardship
This project seeks to contribute to AHRQ's mission by assisting
nursing homes to optimize antimicrobial (e.g., antibiotics and
antifungals) prescribing practices, also referred to as antimicrobial
stewardship. Antimicrobial stewardship programs reduce the development
of drug-resistant organisms, enhance patient outcomes, and reduce
unnecessary costs.
Nursing homes serve as one of our most fertile breeding grounds for
antibiotic-resistant strains of bacteria. This stems from high rates of
infection in nursing home residents due to the effects of normal aging
combined with multiple chronic diseases. The most common infections
encountered in nursing home residents are pneumonia, urinary tract
infections, and skin and soft tissue infections. In one study by
Yoshikawa and Norman, researchers found that these three types of
infections accounted for approximately 75 percent of all nursing home-
associated infections (NHAIs) . High rates of these infections lead to
antimicrobials being among the most commonly prescribed pharmaceuticals
in long-term care settings. In nursing homes, where polypharmacy is the
rule rather than the exception, as many as 40 percent of all
prescriptions are for antimicrobial agents, and depending on the study,
25 percent to 75 percent have been deemed inappropriately prescribed.
Such inappropriate prescribing results in negative outcomes, including
adverse drug events, hospital admissions, and higher health care costs.
Most significantly, inappropriate antimicrobial prescribing gives rise
to the development of multi-drug resistant organisms (MDROs), including
Methicillin-resistant Staphylococcus aureus, Vancomycin-resistant
Enterococci, and fluoroquinolone-resistant strains of a variety of
bacteria, and leads to the development of Clostridium difficile
infections.
In general, determining ``appropriateness'' of antimicrobial use in
healthcare settings is challenging to standardize. This becomes even
more complicated in the nursing home setting because most antimicrobial
courses are started empirically (without results from labs) due to the
limited diagnostics available to many nursing homes. In an effort to
address the need for optimizing antibiotic use in the nursing homes,
AHRQ is testing a Guide to Nursing Home Antimicrobial Stewardship (the
Guide). The Guide is intended to help nursing home staff easily
identify toolkits that have been shown to be effective in optimizing
antimicrobial use. There are multiple toolkits that could be used by a
nursing home, and nursing homes face a potentially time-consuming
decision process to choose the most appropriate one. The Guide is
intended to help nursing homes make this choice efficiently and
effectively.
The research has the following goals:
Develop a nursing home-specific antimicrobial stewardship guide,
containing toolkits to assist nursing homes to optimize antimicrobial
prescribing practices, monitor microbes and antimicrobial use, enhance
communication between nursing home staff and attending clinicians, and
enhance communication and engagement with residents and family members
regarding optimizing antimicrobial practices.
Evaluate the ability of nursing homes to use the Guide and improve
antimicrobial use through better stewardship.
Develop a plan to ensure wide dissemination of the findings and
recommendations for antimicrobial stewardship uptake in nursing homes.
This study is being conducted by AHRQ through its contractor,
American Institutes for Research, 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
To achieve the goals of this project the following data collections
will be implemented:
(1) Medical Record Review (MRR). The MRR will be used to obtain
data about antimicrobial prescribing practices, infection prevalence,
and residents' health and functional statuses. These data will be used
in the evaluation of the Guide's impact. Members of the research team
will review the nursing home's medical charts, the Nursing Home Minimum
Data Set (MDS), and the nursing home's infection control log for an
evaluation period of at least 12 months (6 months before and 6 months
after the introduction of the Guide). The MDS is part of the federally
mandated process for clinical assessment of all residents in Medicare
and Medicaid certified nursing homes. This process provides a
comprehensive assessment of each resident's functional capabilities and
helps nursing home staff identify health problems. Care Area
Assessments are part of this process, and provide the foundation upon
which a resident's individual care plan is formulated. MDS assessments
are completed for all residents in certified nursing homes, regardless
of source of payment for the individual resident. AHRQ will support
data abstraction at all nursing homes.
(2) Cost Data Analysis. AHRQ will use the number and type of
antimicrobial prescriptions and secondary estimates of the unit cost of
these prescriptions, obtained from external sources, to compute the
marginal impact of the Guide on the cost of antimicrobials for nursing
homes.
(3) Pre-intervention Interviews with nursing home leaders. The
purpose of these interviews is to gain an understanding of perceptions
and current activities regarding antimicrobial stewardship and to
assess the likelihood that the Guide will be used with a reasonable
degree of fidelity to the implementation plan. This will involve both
closed and open-ended interviews with nursing home leaders
(administrator, director of nursing, assistant director of nursing,
and/or medical director). The open ended interviews will examine (1)
how the staff perceive antimicrobial stewardship; (2) the amount of
experience the staff has in antimicrobial stewardship and its processes
for handling the diagnosis and treatment of infections; and (3) which
toolkit or toolkits are likely to be adopted and why. This information
will help us identify interests by nursing homes and potential barriers
to adopting a toolkit
[[Page 29194]]
from the Guide. This information also will be used to develop
dissemination guidance. The closed ended interview questions, will be
comprised of the Absorptive Capacity for Change survey, which asks
about (1) leadership culture; (2) clinician culture; (3) presence of
certified medical directors; and (4) level of antimicrobial
surveillance. For the Evaluation, two leadership staff at each nursing
home will be interviewed for a total of 20 interviews prior to
implementing the intervention.
(4) Passive Technical Assistance (TA). The purpose of collecting
these data is to obtain information on the types of TA needed as they
emerge during the 6-month intervention period. This information will be
used to improve the Guide. AHRQ projects 60 contacts from nursing home
staff involved in implementing the Guide (10 sites, one per month at
each site during the 6-month intervention period).
(5) Proactive TA discussions. The purpose of collecting these data
is to obtain information on the facilitators, challenges, and
unintended consequences of implementing a particular tool or toolkit.
These informal discussions will be held at each nursing home once a
month during the 6-month intervention phase. Staff will be asked about
what activities they are conducting, changes to implementation, any
facilitators, any challenges, and how they have addressed any
challenges. This information will be used to improve the Guide. For the
Evaluation, two individuals from each nursing home are projected to
attend each of the six conference calls for a total of 20 individuals
and a total of 120 contacts.
(6) Post-intervention interviews. The purpose of these interviews
is to identify (1) facilitators and barriers to implementation; (2)
perceived impacts of the Guide on the use of antimicrobials within the
nursing home; (3) the nursing home's views on the business case for the
Guide; and (4) ways to improve the tools. At a minimum two nursing home
leaders and two champions (if different from leaders) will be
interviewed. In addition, depending on the tool or toolkit selected, up
to two prescribing clinicians, two nurses, or two residents or family
members might be interviewed after the 6-month intervention period is
completed. No more than six individuals per nursing home will be
interviewed for a total of 60 interviewees. Interviews may take place
together.
The information described above will be used to evaluate the Guide
and, if found to be effective, develop a wide-spread dissemination plan
for the Guide.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
respondents' time to participate in this information collection.
Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
Number of
Form name Number of responses per Hours per Total burden
respondents respondent response hours
----------------------------------------------------------------------------------------------------------------
Passive TA Collection Protocol.................. 20 3 20/60 20
General Review of the Guide..................... 20 1 2 40
Pre-intervention interview protocol............. 20 1 1 20
Proactive TA discussion protocol................ 20 6 30/60 60
Post-intervention interview protocols........... 60 1 1 60
---------------------------------------------------------------
Total....................................... 140 na na 200
----------------------------------------------------------------------------------------------------------------
Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
Number of Total burden Average hourly Total cost
Form name respondents hours wage rate * burden
----------------------------------------------------------------------------------------------------------------
Passive TA Collection Protocol.................. 20 20 $30.34 $607
General review of the Guide..................... 20 40 30.34 1,214
Pre-intervention interview protocol............. 20 20 30.34 607
Proactive TA discussion protocol................ 20 60 30.34 1,820
Post-intervention interview protocols........... 60 60 30.34 1,820
---------------------------------------------------------------
Total....................................... 140 200 na 6,068
----------------------------------------------------------------------------------------------------------------
* National Compensation Survey: Occupational wages in the United States May 2013, ``U.S. Department of Labor,
Bureau of Labor Statistics.'' We used an average across the following types of staff: Nursing home registered
nurses ($29.81) 29-1141, nursing home licensed practical/vocational nurses ($21.14) 29-2061, and nursing home
administrator ($40.07) 11-9111. Our average was created by adding each of these three and dividing by three
for the average. Sources: https://www.bls.gov/oes/current/oes291141.htm and https://www.bls.gov/oes/current/oes292061.htm; https://www.bls.gov/oes/current/oes119111.htm.
Request for Comments
In accordance with the Paperwork Reduction Act, 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.
[[Page 29195]]
Dated: May 13, 2014.
Richard Kronick,
AHRQ Director.
[FR Doc. 2014-11726 Filed 5-20-14; 8:45 am]
BILLING CODE 4160-90-P
