Agency Information Collection Activities: Proposed Collection; Comment Request, 21235-21238 [2017-09097]

Download as PDF 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 SRADOVICH on DSK3GMQ082PROD with NOTICES SUMMARY: VerDate Sep<11>2014 17:43 May 04, 2017 Jkt 241001 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. BILLING CODE 4160–90–P 21235 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] BILLING CODE 4160–90–P PO 00000 Frm 00050 Fmt 4703 Sfmt 4703 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 E:\FR\FM\05MYN1.SGM 05MYN1 SRADOVICH on DSK3GMQ082PROD with NOTICES 21236 Federal Register / Vol. 82, No. 86 / Friday, May 5, 2017 / Notices 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. VerDate Sep<11>2014 17:43 May 04, 2017 Jkt 241001 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 PO 00000 Frm 00051 Fmt 4703 Sfmt 4703 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 E:\FR\FM\05MYN1.SGM 05MYN1 21237 Federal Register / Vol. 82, No. 86 / Friday, May 5, 2017 / Notices 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 .......................................................................................................... SRADOVICH on DSK3GMQ082PROD with NOTICES 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. http://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 http://www.bls.gov/oes/current/oes319092.htm. 2 http://www.bls.gov/oes/current/oes434171.htm. VerDate Sep<11>2014 17:43 May 04, 2017 Jkt 241001 PO 00000 Frm 00052 Fmt 4703 Sfmt 4703 E:\FR\FM\05MYN1.SGM 05MYN1 21238 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] BILLING CODE 4160–90–P 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 SRADOVICH on DSK3GMQ082PROD with NOTICES SUMMARY: VerDate Sep<11>2014 17:43 May 04, 2017 Jkt 241001 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 PO 00000 Frm 00053 Fmt 4703 Sfmt 4703 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 E:\FR\FM\05MYN1.SGM 05MYN1

Agencies

[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

[[Page 21237]]

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. http://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\ http://www.bls.gov/oes/current/oes319092.htm.
\2\ http://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