Agency Information Collection Activities: Proposed Collection; Comment Request, 21235-21238 [2017-09097]
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Federal Register / Vol. 82, No. 86 / Friday, May 5, 2017 / Notices
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.
Sharon B. Arnold,
Acting Director.
[FR Doc. 2017–09090 Filed 5–4–17; 8:45 am]
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Agency for Healthcare Research and
Quality; Notice of Meetings
Agency for Healthcare Research
and Quality (AHRQ), HHS.
ACTION: Notice of five AHRQ
subcommittee meetings.
AGENCY:
The subcommittees listed
below are part of AHRQ’s Health
Services Research Initial Review Group
Committee. Grant applications are to be
reviewed and discussed at these
meetings. Each subcommittee meeting
will commence in open session before
closing to the public for the duration of
the meeting. These meetings will be
closed to the public in accordance with
5 U.S.C. App. 2 section 10(d), 5 U.S.C.
552b(c)(4), and 5 U.S.C. 552b(c)(6).
DATES: See below for dates of meetings:
1. Health Care Research and Training
(HCRT)
Date: May 25–26, 2017 (Open from
8:00 a.m. to 8:30 a.m. on May 25
and closed for remainder of the
meeting)
2. Healthcare Information Technology
Research (HITR)
Date: June 7–9, 2017 (Open from 6:00
p.m. to 6:30 p.m. on June 7 and
closed for remainder of the meeting)
3. Health System and Value Research
(HSVR)
Date: June 14–15, 2017 (Open from
8:30 a.m. to 9:00 a.m. on June 14
and closed for remainder of the
meeting)
4. Healthcare Effectiveness and
Outcomes Research (HEOR)
Date: June 14–15, 2017 (Open from
8:30 a.m. to 9:00 a.m. on June 14
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and closed for remainder of the
meeting)
5. Healthcare Safety and Quality
Improvement Research (HSQR)
Date: June 22–23, 2017 (Open from
8:00 a.m. to 8:30 a.m. on June 22
and closed for remainder of the
meeting)
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
ADDRESSES:
(Below specifics where each
hotel will be held)
AGENCY:
Gaithersburg Marriott, 9751
Washingtonian Blvd., Gaithersburg,
Maryland 20878.
SUMMARY:
(To
obtain a roster of members, agenda or
minutes of the non-confidential portions
of the meetings.)
FOR FURTHER INFORMATION CONTACT:
Mrs. Bonnie Campbell, Committee
Management Officer, Office of
Extramural Research Education and
Priority Populations, Agency for
Healthcare Research and Quality
(AHRQ), 5600 Fishers Lane,
Rockville, Maryland 20857,
Telephone (301) 427–1554.
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SUPPLEMENTARY INFORMATION:
In accordance with section 10 (a)(2) of
the Federal Advisory Committee Act (5
U.S.C. App. 2), AHRQ announces
meetings of the above-listed scientific
peer review groups, which are
subcommittees of AHRQ’s Health
Services Research Initial Review Group
Committees. Each subcommittee
meeting will commence in open session
before closing to the public for the
duration of the meeting. The
subcommittee meetings will be closed to
the public in accordance with the
provisions set forth in 5 U.S.C. App. 2
section 10(d), 5 U.S.C. 552b(c)(4), and 5
U.S.C. 552b(c)(6) The grant applications
and the discussions could disclose
confidential trade secrets or commercial
property such as patentable material,
and personal information concerning
individuals associated with the grant
applications, the disclosure of which
would constitute a clearly unwarranted
invasion of personal privacy.
Agenda items for these meetings are
subject to change as priorities dictate.
Sharon B. Arnold,
Acting Director.
[FR Doc. 2017–09130 Filed 5–4–17; 8:45 am]
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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.
ACTION: 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 ‘‘The Reengineered Visit for Primary Care.’’
This proposed information collection
was previously published in the Federal
Register on February 13, 2017 and
allowed 60 days for public comment.
AHRQ received one comment from the
public. The purpose of this notice is to
allow an additional 30 days for public
comment.
DATES: Comments on this notice must be
received by June 5, 2017.
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
email at OIRA_submission@
omb.eop.gov (attention: AHRQ’s desk
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
The Re-Engineered Visit for Primary
Care
In accordance with the Paperwork
Reduction Act, 44 U.S.C. 3501–3521,
AHRQ invites the public to comment on
this proposed information collection.
This project, The Re-engineered Visit for
Primary Care, directly addresses the
agency’s goal to conduct research to
enhance the quality of health care and
reduce avoidable readmissions, which
are a major indicator of poor quality and
patient safety.
Research from AHRQ’s Healthcare
Cost and Utilization Project (HCUP)
indicates that in 2011 there were
approximately 3.3 million adult hospital
readmissions in the United States.
Adults covered by Medicare have the
highest readmission rate (17.2 per 100
admissions), followed by adults covered
by Medicaid (14.6 per 100 admissions)
and privately insured adults (8.7 per
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100 admissions). High rates of
readmissions are a major patient safety
problem and are associated with a range
of adverse events, such as prescribing
errors and misdiagnoses of conditions in
the hospital and ambulatory care
settings. Collectively these readmissions
are associated with $41.3 billion in
annual hospital costs, many of which
potentially could be avoided.
In recent years, payer and provider
efforts to reduce readmissions have
proliferated. Many of these national
programs have been informed or guided
by evidence-based research, toolkits and
guides, such as AHRQ’s RED (ReEngineered Discharge), STAAR (STate
Action on Avoidable Readmission),
AHRQ’s Project BOOST (Better
Outcomes by Optimizing Safe
Transitions), the Hospital Guide to
Reducing Medicaid Readmissions, and
Eric Coleman’s Care Transitions
Intervention. These efforts have largely
focused on enhancing practices
occurring within the hospital setting,
including the discharge process
transitions among providers and
between settings of care. While many of
these efforts have recognized the critical
role of primary care in managing care
transitions, they have not had an
explicit focus on enhancing primary
care with the aim of reducing avoidable
readmissions.
Evidence-based guidance to reduce
readmissions and improve patient safety
are comparatively lacking for the
primary care setting. This gap in the
literature is becoming more pronounced
as primary care is increasingly serving
as the key integrator across the health
system as part of payment and delivery
system reforms. This research project
aims to address the important and
unfulfilled need to improve patient
safety and reduce avoidable
readmissions within the primary care
context.
AHRQ’s goals in supporting this 30month project are to build on the
knowledge base from the inpatient
settings, add to the expanding evidence
base on preventing readmissions by
focusing on the primary care setting,
and provide insight on the components
and themes that should be part of a reengineered visit in primary care. This
work will ultimately inform an effective
intervention that can be tested in a
diverse set of primary care clinics.
To meet AHRQ’s goals and objectives,
the agency awarded a task order to John
Snow, Inc. (JSI) to conduct qualitative
research using quality improvement to
investigate the primary care-based
transitional care workflow from the
primary care staff, patient, and
community agency perspective.
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This research has the following goals:
1. Analyze current processes in the
primary care visit associated with
hospital discharge; and
2. Identify components of the reengineered visit.
This study is being conducted by
AHRQ through its contractor 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 the quality, effectiveness,
efficiency, appropriateness and vale of
health care services and with respect to
quality measurement and improvement.
42 U.S.C 299a(a)(1) and (2).
Method of Collection
To analyze current processes in the
primary care visit associated with
hospital discharge, the data collection is
separated into seven smaller data
collection activities to minimize
research participant burden while still
allowing for the collection of necessary
data. Each of these tasks will be
conducted at nine primary care sites:
1. Primary care site organizational
characteristics survey: The purpose of
this background information on the
primary care site’s organizational
characteristics is to offer context for the
work flow mapping. It will help make
the work flow mapping process more
efficient and reduce burden by only
requesting information that is already
known by each site contact. One person
per primary care site will be engaged for
this task.
2. Primary care site patient
characteristics survey: The purpose of
this background information on the
primary care site’s patients is to offer
context for the work flow mapping. It
will help make the work flow mapping
process more efficient and reduce
burden by only requesting information
that is already known in the primary
care practices’ billing or clinical
information systems. One person per
primary care site will be engaged for
this task.
3. Work flow mapping preliminary
interviews: The purpose of this flow
mapping ‘‘pre-work’’ is to engage
individual primary care staff members
to think about the current work flow
map in order to set a foundation for the
actual work flow mapping process. It is
anticipated that eight individuals per
primary care site will participate, for a
total of 72 participants.
4. Work flow mapping: This collection
will take place in a group meeting that
brings together staff from various role
types to collaborate in identifying their
workflow processes involved in
planning for and executing post-hospital
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follow up services for their patients.
Based on feasibility, these may be
smaller or larger group meetings, but the
total burden on each role type
participant is the same. The end goal of
this meeting is to have enough
information to develop an initial
process flow map on paper. It is
anticipated that 10 individuals per
primary care site will participate, for a
total of 90 participants.
5. Work flow mapping follow-up
interviews: Once the initial process flow
map is on paper, each role type will be
asked to review to correct, add, or
confirm detail to the document. Once
the flow map has been edited and
ratified by the primary care site staff,
each role type will be asked specific
questions regarding the flaws identified
in the process flow for the failure mode
effects analysis. It is anticipated that
eight individuals per primary care site
will participate, for a total of 72
participants.
6. Patient Interviews: As a
complement to the work flow mapping,
there will also be a process flow map
developed from the patient’s
perspective. The purpose of the patient
interviews is to capture patient
perspectives on potential breakdowns in
making the transition from the hospital
to care in the primary care settings and
to get, in their own words, information
about the initial hospitalization and
barriers to accessing follow-up care. One
of the widely acknowledged limitations
of the existing evidence based toolkits is
that they are not designed with input
from patients.
This has occurred despite the fact that
clinical experience suggests that
providers often fail to identify patient
needs and concerns. Research has
shown that there are cultural, social,
and behavioral factors that may
contribute to readmissions and
assessing the patient’s perspective can
help to better understand the barriers to
receiving appropriate follow-up care.
Patient and family interviews are
increasingly common practices in efforts
to improve care transitions and reduce
readmissions, endorsed by CMS, the
Institute for Healthcare Improvement,
Kaiser Permanente, and others. This
patient interview will collect unique
information on the barriers to effective
care transitions in the post-discharge
period care, information which cannot
be collected in other ways. It is
anticipated that ten post-discharge
patients per primary care site will be
interviewed for a total of 90 patients.
7. Community agency interviews: As a
complement to the work flow mapping,
the process flow map developed will
reflect the perspective of community
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agencies affiliated with the primary care
sites to assist patients. It is anticipated
that five community agency
representatives per primary care site
will be interviewed.
The purpose of this data collection is
to understand the key components that
should be included in the re-engineered
visit in primary care. The project team
will examine the diverse settings, staff,
and transitional care activities across a
variety of primary care practices to
identify key transitional care processes
that impact patient outcomes, the
challenges to implementing those
processes, and ways to improve those
processes.
The project team will distill the
themes and principles that should be a
part of the re-engineered visit and
develop an outline and summary of its
components, with a comparison/
contrast of the components across sites
and discussion of the generalizability of
these components to different settings.
The results of this research will add
to the expanding evidence base on
preventing readmissions by focusing on
the primary care setting, and provide
insight on the components and themes
that should be part of a re-engineered
visit. This information will ultimately
inform an effective intervention that can
be tested in a diverse set of primary care
clinics.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated burden
hours to the respondents for providing
all of the data needed to meet the
project’s objectives. The hours estimated
per responses are based on the pilot
project results.
For the primary care site
organizational characteristics survey
and patient characteristics survey, one
person per each of the nine primary care
sites will participate. Both surveys are
anticipated to take 1.5 hours to
complete.
For the work flow mapping
preliminary interviews, we estimate that
eight primary care staff per primary care
site will participate, with each
individual spending 0.5 hours in these
interviews. For the work flow mapping
group interview, we estimate that 10
primary care staff per primary care site
will participate, with each individual
spending 1.5 hours in these interviews.
Finally, we estimate that eight primary
care staff per primary care site will
participate in the work flow mapping
follow-up interviews, with each
individual spending 0.5 hours in this
data collection activity.
There will be 10 patients interviewed
in association with each primary care
site. These patient interviews are
expected to take 0.5 hours per
individual research participant.
Lastly, there will be five community
agency staff members interviewed in
association with each primary care site.
These interviews are expected to take 1
hour per individual research
participant.
Exhibit 2 shows the estimated cost
burden for the respondents’ time to
participate in the project. The total
annualized cost burden is estimated at
$11,500.30.
EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS
Number of
respondents
Form name
Number of
responses per
respondent
Hours per
response
Total burden
hours
Primary care site organizational characteristics survey ..................................
Primary care site patient characteristics survey ..............................................
Workflow mapping preliminary interview .........................................................
Workflow mapping group interview ..................................................................
Workflow mapping follow-up interview ............................................................
Patient interview ..............................................................................................
Community agency interview ...........................................................................
9
9
72
90
72
90
45
1
1
1
1
1
1
1
1.5
1.5
0.5
1.5
0.5
0.5
1
13.5
13.5
36
135
36
45
45
Total ..........................................................................................................
387
n/a
n/a
2,628
EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN
Number of
respondents
Form name
Total burden
hours
Average
hourly
wage rate *
Total cost
burden
9
9
72
90
72
90
45
13.5
13.5
36
135
36
45
45
a $40.41
c 22.20
$545.54
545.54
1,454.76
5,455.35
1,454.76
1,045.35
999.00
Total ..........................................................................................................
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Primary care site organizational characteristics survey ..................................
Primary care site patient characteristics survey ..............................................
Workflow mapping preliminary interview .........................................................
Workflow mapping group interview ..................................................................
Workflow mapping follow-up interview ............................................................
Patient interview ..............................................................................................
Community agency interview ...........................................................................
387
n/a
n/a
11,500.30
a 40.41
a 40.41
a 40.41
a 40.41
b 23.23
* For hourly average wage rates, mean hourly wages from the Bureau of Labor Statistics (BLS) May 2015 national occupational employment
wage estimates were used. https://www.bls.gov/oes/current/oes_nat.htm#00–0000.
a Participants will include a mix of providers and front desk staff; therefore a blended rate for these tasks are used including Nurse ($33.55),
Medical Assistant ($15.01 1), Front Desk Staff ($13.38 2), Program Director ($32.56), Pharmacist ($56.96), Physician ($91.60), Behavioral health
provider ($22.03).
b Based upon the mean wages for consumers (all occupations).
c Based upon the mean wages for Social Workers.
1 https://www.bls.gov/oes/current/oes319092.htm.
2 https://www.bls.gov/oes/current/oes434171.htm.
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Federal Register / Vol. 82, No. 86 / Friday, May 5, 2017 / 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
comments will become a matter of
public record.
Sharon B. Arnold,
Acting Director.
[FR Doc. 2017–09097 Filed 5–4–17; 8:45 am]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
Meeting of the Community Preventive
Services Task Force (Task Force)
Centers for Disease Control and
Prevention (CDC), Department of Health
and Human Services (HHS).
ACTION: Notice of meeting.
AGENCY:
The Centers for Disease
Control and Prevention (CDC) within
the Department of Health and Human
Services announces the next meeting of
the Community Preventive Services
Task Force (Task Force) on June 14–15,
2017 in Atlanta, Georgia.
DATES: The meeting will be held on
Wednesday, June 14, 2017 from 8:30
a.m. to 6:00 p.m. EDT and Thursday,
June 15, 2017 from 8:30 a.m. to 1:00
p.m. EDT.
ADDRESSES: The Task Force Meeting
will be held at the CDC Edward R.
Roybal Campus, Centers for Disease
Control and Prevention Headquarters
(Building 19), 1600 Clifton Road NE.,
Atlanta, GA 30329. You should be
aware that the meeting location is in a
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SUMMARY:
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Federal government building; therefore,
strict Federal security measures are
applicable. For additional information,
please see Roybal Campus Security
Guidelines under SUPPLEMENTARY
INFORMATION. Information regarding
meeting logistics will be available on
the Community Guide Web site
(www.thecommunityguide.org) closer to
the date of the meeting.
Meeting Accessability: This spacelimited meeting is open to the public.
All meeting attendees must register to
ensure completion of required security
procedures and access to the CDC’s
Global Communications Center.
Public Comment: A public comment
period, limited to three minutes per
person, will follow the Task Force’s
discussion of each systematic review.
Individuals wishing to make public
comments must indicate their desire to
do so in advance by providing their
name, organizational affiliation, and the
topic to be addressed (if known) with
their registration. Public comments will
become part of the meeting summary.
Public comment is not possible via
Webcast.
U.S. citizens must register by June 7,
2017. To satisfy security requirements,
Non U.S. citizens must register by May
29, 2017. Failure to register by the dates
identified could result in the inability to
attend the Task Force meeting.
Meeting Accessibility: This meeting is
available to the public via Webcast. CDC
will send the Webcast URL to registrants
upon receipt of their registration. All
meeting attendees must register to
receive the webcast information. CDC
will email webcast information from the
CPSTF@cdc.gov mailbox.
FOR FURTHER INFORMATION/REGISTRATION,
CONTACT: Onslow Smith, Center for
Surveillance, Epidemiology and
Laboratory Services, Centers for Disease
Control and Prevention, 1600 Clifton
Road NE., MS–E–69, Atlanta, GA 30329,
phone: (404) 498–6778, email: CPSTF@
cdc.gov.
SUPPLEMENTARY INFORMATION:
Background on the CPSTF: The Task
Force is an independent, nonpartisan,
nonfederal, and unpaid panel. Its
members represent a broad range of
research, practice, and policy expertise
in prevention, wellness, health
promotion, and public health, and are
appointed by the CDC Director. The
Task Force was convened in 1996 by the
Department of Health and Human
Services (HHS) to identify community
preventive programs, services, and
policies that increase healthy longevity,
save lives and dollars, and improve
Americans’ quality of life. CDC is
mandated to provide ongoing
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administrative, research, and technical
support for the operations of the Task
Force. During its meetings, the Task
Force considers the findings of
systematic reviews on existing research
and practice-based evidence and issues
recommendations. Task Force
recommendations are not mandates for
compliance or spending. Instead, they
provide information about evidencebased options that decision makers and
stakeholders can consider when they are
determining what best meets the
specific needs, preferences, available
resources, and constraints of their
jurisdictions and constituents. The Task
Force’s recommendations, along with
the systematic reviews of the evidence
on which they are based, are compiled
in the Guide to Community Preventive
Services (The Community Guide).
At the meetings, the Task Force
considers systematic reviews and issues
findings and recommendations based on
the reviews. Task Force
recommendations provide information
about evidence-based options that
decision makers and stakeholders can
consider when they are determining
what best meets the specific needs,
preferences, available resources, and
constraints of their jurisdictions and
constituents.
Matters proposed for discussion*:
Diabetes prevention: Diabetes
Prevention and Control (Effectiveness of
Mobile Phone Applications to Improve
Glycemic Control (HbA1c) in the Selfmanagement of Diabetes); Obesity
Prevention and Control (Economics of
School-based Interventions for Obesity
Prevention Availability of Healthy Food
and Beverage (AHFB) and Snack Food
and Beverage (SFB)); Physical Activity
(Effectiveness of Activity Monitors for
Increasing Physical Activity in Adults
with Overweight or Obesity); Nutrition
(Telehealth Methods to Deliver Dietary
Interventions in Adults with Chronic
Disease); and Women’s Health
(Effectiveness of Interventions for the
Primary Prevention of Intimate Partner
Violence and Sexual Violence Among
Youth). The agenda is subject to change
without notice.
Roybal Campus Security Guidelines:
The Edward R. Roybal Campus is the
headquarters of the CDC and is located
at 1600 Clifton Road NE., Atlanta,
Georgia. The meeting is being held in a
Federal government building; therefore,
Federal security measures are
applicable.
All meeting attendees must RSVP by
the dates outlined under Meeting
Accessability. In planning your arrival
time, please take into account the need
to park and clear security. All visitors
must enter the Edward R. Roybal
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[Federal Register Volume 82, Number 86 (Friday, May 5, 2017)]
[Notices]
[Pages 21235-21238]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-09097]
-----------------------------------------------------------------------
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 ``The Re-engineered Visit for Primary Care.''
This proposed information collection was previously published in
the Federal Register on February 13, 2017 and allowed 60 days for
public comment. AHRQ received one comment from the public. The purpose
of this notice is to allow an additional 30 days for public comment.
DATES: Comments on this notice must be received by June 5, 2017.
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
email at OIRA_submission@omb.eop.gov (attention: AHRQ's desk 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
The Re-Engineered Visit for Primary Care
In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-
3521, AHRQ invites the public to comment on this proposed information
collection. This project, The Re-engineered Visit for Primary Care,
directly addresses the agency's goal to conduct research to enhance the
quality of health care and reduce avoidable readmissions, which are a
major indicator of poor quality and patient safety.
Research from AHRQ's Healthcare Cost and Utilization Project (HCUP)
indicates that in 2011 there were approximately 3.3 million adult
hospital readmissions in the United States. Adults covered by Medicare
have the highest readmission rate (17.2 per 100 admissions), followed
by adults covered by Medicaid (14.6 per 100 admissions) and privately
insured adults (8.7 per
[[Page 21236]]
100 admissions). High rates of readmissions are a major patient safety
problem and are associated with a range of adverse events, such as
prescribing errors and misdiagnoses of conditions in the hospital and
ambulatory care settings. Collectively these readmissions are
associated with $41.3 billion in annual hospital costs, many of which
potentially could be avoided.
In recent years, payer and provider efforts to reduce readmissions
have proliferated. Many of these national programs have been informed
or guided by evidence-based research, toolkits and guides, such as
AHRQ's RED (Re-Engineered Discharge), STAAR (STate Action on Avoidable
Readmission), AHRQ's Project BOOST (Better Outcomes by Optimizing Safe
Transitions), the Hospital Guide to Reducing Medicaid Readmissions, and
Eric Coleman's Care Transitions Intervention. These efforts have
largely focused on enhancing practices occurring within the hospital
setting, including the discharge process transitions among providers
and between settings of care. While many of these efforts have
recognized the critical role of primary care in managing care
transitions, they have not had an explicit focus on enhancing primary
care with the aim of reducing avoidable readmissions.
Evidence-based guidance to reduce readmissions and improve patient
safety are comparatively lacking for the primary care setting. This gap
in the literature is becoming more pronounced as primary care is
increasingly serving as the key integrator across the health system as
part of payment and delivery system reforms. This research project aims
to address the important and unfulfilled need to improve patient safety
and reduce avoidable readmissions within the primary care context.
AHRQ's goals in supporting this 30-month project are to build on
the knowledge base from the inpatient settings, add to the expanding
evidence base on preventing readmissions by focusing on the primary
care setting, and provide insight on the components and themes that
should be part of a re-engineered visit in primary care. This work will
ultimately inform an effective intervention that can be tested in a
diverse set of primary care clinics.
To meet AHRQ's goals and objectives, the agency awarded a task
order to John Snow, Inc. (JSI) to conduct qualitative research using
quality improvement to investigate the primary care-based transitional
care workflow from the primary care staff, patient, and community
agency perspective.
This research has the following goals:
1. Analyze current processes in the primary care visit associated
with hospital discharge; and
2. Identify components of the re-engineered visit.
This study is being conducted by AHRQ through its contractor
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 the quality, effectiveness, efficiency,
appropriateness and vale of health care services and with respect to
quality measurement and improvement. 42 U.S.C 299a(a)(1) and (2).
Method of Collection
To analyze current processes in the primary care visit associated
with hospital discharge, the data collection is separated into seven
smaller data collection activities to minimize research participant
burden while still allowing for the collection of necessary data. Each
of these tasks will be conducted at nine primary care sites:
1. Primary care site organizational characteristics survey: The
purpose of this background information on the primary care site's
organizational characteristics is to offer context for the work flow
mapping. It will help make the work flow mapping process more efficient
and reduce burden by only requesting information that is already known
by each site contact. One person per primary care site will be engaged
for this task.
2. Primary care site patient characteristics survey: The purpose of
this background information on the primary care site's patients is to
offer context for the work flow mapping. It will help make the work
flow mapping process more efficient and reduce burden by only
requesting information that is already known in the primary care
practices' billing or clinical information systems. One person per
primary care site will be engaged for this task.
3. Work flow mapping preliminary interviews: The purpose of this
flow mapping ``pre-work'' is to engage individual primary care staff
members to think about the current work flow map in order to set a
foundation for the actual work flow mapping process. It is anticipated
that eight individuals per primary care site will participate, for a
total of 72 participants.
4. Work flow mapping: This collection will take place in a group
meeting that brings together staff from various role types to
collaborate in identifying their workflow processes involved in
planning for and executing post-hospital follow up services for their
patients. Based on feasibility, these may be smaller or larger group
meetings, but the total burden on each role type participant is the
same. The end goal of this meeting is to have enough information to
develop an initial process flow map on paper. It is anticipated that 10
individuals per primary care site will participate, for a total of 90
participants.
5. Work flow mapping follow-up interviews: Once the initial process
flow map is on paper, each role type will be asked to review to
correct, add, or confirm detail to the document. Once the flow map has
been edited and ratified by the primary care site staff, each role type
will be asked specific questions regarding the flaws identified in the
process flow for the failure mode effects analysis. It is anticipated
that eight individuals per primary care site will participate, for a
total of 72 participants.
6. Patient Interviews: As a complement to the work flow mapping,
there will also be a process flow map developed from the patient's
perspective. The purpose of the patient interviews is to capture
patient perspectives on potential breakdowns in making the transition
from the hospital to care in the primary care settings and to get, in
their own words, information about the initial hospitalization and
barriers to accessing follow-up care. One of the widely acknowledged
limitations of the existing evidence based toolkits is that they are
not designed with input from patients.
This has occurred despite the fact that clinical experience
suggests that providers often fail to identify patient needs and
concerns. Research has shown that there are cultural, social, and
behavioral factors that may contribute to readmissions and assessing
the patient's perspective can help to better understand the barriers to
receiving appropriate follow-up care.
Patient and family interviews are increasingly common practices in
efforts to improve care transitions and reduce readmissions, endorsed
by CMS, the Institute for Healthcare Improvement, Kaiser Permanente,
and others. This patient interview will collect unique information on
the barriers to effective care transitions in the post-discharge period
care, information which cannot be collected in other ways. It is
anticipated that ten post-discharge patients per primary care site will
be interviewed for a total of 90 patients.
7. Community agency interviews: As a complement to the work flow
mapping, the process flow map developed will reflect the perspective of
community
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agencies affiliated with the primary care sites to assist patients. It
is anticipated that five community agency representatives per primary
care site will be interviewed.
The purpose of this data collection is to understand the key
components that should be included in the re-engineered visit in
primary care. The project team will examine the diverse settings,
staff, and transitional care activities across a variety of primary
care practices to identify key transitional care processes that impact
patient outcomes, the challenges to implementing those processes, and
ways to improve those processes.
The project team will distill the themes and principles that should
be a part of the re-engineered visit and develop an outline and summary
of its components, with a comparison/contrast of the components across
sites and discussion of the generalizability of these components to
different settings.
The results of this research will add to the expanding evidence
base on preventing readmissions by focusing on the primary care
setting, and provide insight on the components and themes that should
be part of a re-engineered visit. This information will ultimately
inform an effective intervention that can be tested in a diverse set of
primary care clinics.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated burden hours to the respondents for
providing all of the data needed to meet the project's objectives. The
hours estimated per responses are based on the pilot project results.
For the primary care site organizational characteristics survey and
patient characteristics survey, one person per each of the nine primary
care sites will participate. Both surveys are anticipated to take 1.5
hours to complete.
For the work flow mapping preliminary interviews, we estimate that
eight primary care staff per primary care site will participate, with
each individual spending 0.5 hours in these interviews. For the work
flow mapping group interview, we estimate that 10 primary care staff
per primary care site will participate, with each individual spending
1.5 hours in these interviews. Finally, we estimate that eight primary
care staff per primary care site will participate in the work flow
mapping follow-up interviews, with each individual spending 0.5 hours
in this data collection activity.
There will be 10 patients interviewed in association with each
primary care site. These patient interviews are expected to take 0.5
hours per individual research participant.
Lastly, there will be five community agency staff members
interviewed in association with each primary care site. These
interviews are expected to take 1 hour per individual research
participant.
Exhibit 2 shows the estimated cost burden for the respondents' time
to participate in the project. The total annualized cost burden is
estimated at $11,500.30.
Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
Number of
Form name Number of responses per Hours per Total burden
respondents respondent response hours
----------------------------------------------------------------------------------------------------------------
Primary care site organizational characteristics 9 1 1.5 13.5
survey.........................................
Primary care site patient characteristics survey 9 1 1.5 13.5
Workflow mapping preliminary interview.......... 72 1 0.5 36
Workflow mapping group interview................ 90 1 1.5 135
Workflow mapping follow-up interview............ 72 1 0.5 36
Patient interview............................... 90 1 0.5 45
Community agency interview...................... 45 1 1 45
---------------------------------------------------------------
Total....................................... 387 n/a n/a 2,628
----------------------------------------------------------------------------------------------------------------
Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
Average
Form name Number of Total burden hourly wage Total cost
respondents hours rate * burden
----------------------------------------------------------------------------------------------------------------
Primary care site organizational characteristics 9 13.5 \a\ $40.41 $545.54
survey.........................................
Primary care site patient characteristics survey 9 13.5 \a\ 40.41 545.54
Workflow mapping preliminary interview.......... 72 36 \a\ 40.41 1,454.76
Workflow mapping group interview................ 90 135 \a\ 40.41 5,455.35
Workflow mapping follow-up interview............ 72 36 \a\ 40.41 1,454.76
Patient interview............................... 90 45 \b\ 23.23 1,045.35
Community agency interview...................... 45 45 \c\ 22.20 999.00
---------------------------------------------------------------
Total....................................... 387 n/a n/a 11,500.30
----------------------------------------------------------------------------------------------------------------
* For hourly average wage rates, mean hourly wages from the Bureau of Labor Statistics (BLS) May 2015 national
occupational employment wage estimates were used. https://www.bls.gov/oes/current/oes_nat.htm#00-0000.
\a\ Participants will include a mix of providers and front desk staff; therefore a blended rate for these tasks
are used including Nurse ($33.55), Medical Assistant ($15.01 \1\), Front Desk Staff ($13.38 \2\), Program
Director ($32.56), Pharmacist ($56.96), Physician ($91.60), Behavioral health provider ($22.03).
\b\ Based upon the mean wages for consumers (all occupations).
\c\ Based upon the mean wages for Social Workers.
\1\ https://www.bls.gov/oes/current/oes319092.htm.
\2\ https://www.bls.gov/oes/current/oes434171.htm.
[[Page 21238]]
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.
Sharon B. Arnold,
Acting Director.
[FR Doc. 2017-09097 Filed 5-4-17; 8:45 am]
BILLING CODE 4160-90-P