Agency Information Collection Activities: Proposed Collection; Comment Request, 53064-53066 [2014-20422]
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Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Notices
SUPPLEMENTARY INFORMATION:
GENERAL SERVICES
ADMINISTRATION
[Notice–CECANF–2014–05; Docket No.
2014–0006; Sequence No. 5]
Commission To Eliminate Child Abuse
and Neglect Fatalities; Announcement
of Meeting
Commission to Eliminate Child
Abuse and Neglect Fatalities, GSA.
ACTION: Meeting Notice.
AGENCY:
The Commission to Eliminate
Child Abuse and Neglect Fatalities
(CECANF), a Federal Advisory
Committee established by the Protect
Our Kids Act of 2012, Public Law 112–
275, will hold a meeting open to the
public on Monday, September 22 and
Tuesday, September 23, 2014 in Denver,
Colorado.
DATES: The meeting will be held on
Monday, September 22 2014, from 8:30
a.m. to 5:00 p.m., and Tuesday,
September 23, from 8:30 a.m.–2:30 p.m.
Mountain Time.
ADDRESSES: CECANF will convene its
meeting at One Denver Federal Center,
Building 41—Remington Arms Room,
Denver, CO 80225. This site is
accessible to individuals with
disabilities. The meeting will also be
made available via teleconference.
Submit comments identified by
‘‘Notice–CECANF–2014–05’’, by either
of the following methods:
• Regulations.gov: https://
www.regulations.gov. Submit comments
via the Federal eRulemaking portal by
searching for ‘‘Notice–CECANF–2014–
05’’. Select the link ‘‘Comment Now’’
that corresponds with ‘‘Notice–
CECANF–2014–05’’. Follow the
instructions provided at screen. Please
include your name, organization name
(if any), and ‘‘Notice–CECANF–2014–
05’’ on your attached document.
• Mail: Commission to Eliminate
Child Abuse and Neglect Fatalities, c/o
General Services Administration,
Agency Liaison Division, 1800 F St.
NW., Room 7003D, Washington, DC
20006.
Instructions: Please submit comments
only and cite ‘‘Notice–CECANF–2014–
05’’ in all correspondence related to this
notice. All comments received will be
posted without change to https://
www.regulations.gov, including any
personal and/or business confidential
information provided.
FOR FURTHER INFORMATION CONTACT: Visit
the CECANF Web site at https://
eliminatechildabusefatalities.sites.usa.
gov/ or contact Ms. Patricia Brincefield,
Communications Director, at 202–818–
9596, 1800 F St. NW., Room 7003D,
Washington, DC 20006.
rmajette on DSK2TPTVN1PROD with NOTICES
SUMMARY:
VerDate Mar<15>2010
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Jkt 232001
Dated: August 26, 2014.
Karen White,
Executive Assistant.
[FR Doc. 2014–21142 Filed 9–4–14; 8:45 am]
BILLING CODE 6820–34–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:
PO 00000
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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
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.
This proposed information collection
was previously published in the Federal
Register on May 21st 2014 and allowed
60 days for public comment. No
comments were 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 October 6, 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:
SUMMARY:
Background: CECANF was
established to develop a national
strategy and recommendations for
reducing fatalities resulting from child
abuse and neglect.
Agenda: The purpose of the meeting
is for Commission members to gather
national and state-specific information
regarding child abuse and neglect
fatalities. The Commission will hear
from researchers and issue experts
regarding the scope of the problem,
strategies for improving national data
collection, policy barriers and
opportunities to reduce maltreatment
fatalities, confidentiality issues, and
potential solutions. Experts from such
disciplines as child welfare, law
enforcement, health, and public health
will present strategies for addressing the
issue of child abuse and neglect
fatalities.
Attendance at the Meeting:
Individuals interested in attending the
meeting in person or participating by
webinar and teleconference line must
register in advance. To register to attend
in person or by webinar/phone, please
go to https://attendee.gotowebinar.com/
register/2847427613386511874 and
follow the prompts. You will receive a
confirmation email once you register
with the webinar login and
teleconference number. Detailed
meeting minutes will be posted within
90 days of the meeting. Members of the
public will not have the opportunity to
ask questions or otherwise participate in
the meeting.
However, members of the public
wishing to comment should follow the
steps detailed under the heading
Addresses in this publication or contact
us via the CECANF Web site at https://
eliminatechildabusefatalities.sites.usa.
gov/contact-us/.
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 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
E:\FR\FM\05SEN1.SGM
05SEN1
rmajette on DSK2TPTVN1PROD with NOTICES
Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Notices
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 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
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Jkt 232001
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
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53065
(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
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
E:\FR\FM\05SEN1.SGM
05SEN1
53066
Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Notices
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.
rmajette on DSK2TPTVN1PROD 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
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
VerDate Mar<15>2010
14:29 Sep 04, 2014
Jkt 232001
comments will become a matter of
public record.
Dated: August 20, 2014.
Richard Kronick,
AHRQ Director.
[FR Doc. 2014–20422 Filed 9–4–14; 8:45 am]
BILLING CODE 4160–90–M
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
[Docket No. CDC–2012–0013]
Notice of Availability of the Final
Environmental Impact Statement
Centers for Disease Control and
Prevention, HHS.
ACTION: Notice of Availability and
Request for Comment.
AGENCY:
The Centers for Disease
Control and Prevention (CDC), within
the Department of Health and Human
Services (HHS), announces the
SUMMARY:
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availability of the Final Environmental
Impact Statement (FEIS) for the Roybal
Campus 2025 Master Plan. The FEIS
analyzes the potential impacts
associated with the implementation of
the 2015–2025 Master Plan (Master
Plan) for HHS/CDC’s Edward R. Roybal
Campus (Roybal Campus) located at
1600 Clifton Road NE., in Atlanta,
Georgia. This announcement follows the
requirements of the National
Environmental Policy Act of 1969
(NEPA) as implemented by the Council
on Environmental Quality (CEQ)
Regulations (40 CFR Part 1500–1508);
and, the Department of Health and
Human Services (HHS) General
Administration Manual Part 30
Environmental Procedures, dated
February 25, 2000.
DATES: The FEIS will be available for
public review and comment through
Monday, October 6, 2014 which
coincides with the publication of the
NOA by the EPA in the Federal
Register. Following the 30 day comment
period, HHS/CDC will issue a Record of
Decision which identifies the Selected
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]]>Agencies
[Federal Register Volume 79, Number 172 (Friday, September 5, 2014)]
[Notices]
[Pages 53064-53066]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-20422]
=======================================================================
-----------------------------------------------------------------------
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 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.
This proposed information collection was previously published in
the Federal Register on May 21st 2014 and allowed 60 days for public
comment. No comments were 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 October 6, 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
[[Page 53065]]
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 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
[[Page 53066]]
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.
Dated: August 20, 2014.
Richard Kronick,
AHRQ Director.
[FR Doc. 2014-20422 Filed 9-4-14; 8:45 am]
BILLING CODE 4160-90-M
