Agency Information Collection Activities: Proposed Collection; Comment Request, 20502-20505 [2020-07661]
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Federal Register / Vol. 85, No. 71 / Monday, April 13, 2020 / Notices
EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN
Number of
respondents
Form name
Total
burden
hours
Average
hourly
wage rate *
Total cost
burden
Registration Form ............................................................................................
Health Plan Information Form .........................................................................
Data Use Agreement .......................................................................................
Questionnaire and Data Files Submission ......................................................
85
75
75
75
7
150
6
300
a 54.68
c 43.07
$383
8,202
577
12,921
Total ..........................................................................................................
310
463
NA
$22,083
a 54.68
b 96.22
* National Compensation Survey: Occupational wages in the United States May 2018, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’
a Based on the mean hourly wage for Medical and Health Services Managers (11–9111).
b Based on the mean hourly wage for Chief Executives (11–1011).
c Based on the mean hourly wages for Computer Programmer (15–1131).
Request for Comments
In accordance with the Paperwork
Reduction Act of 1995, 44 U.S.C. 3501–
3521, 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: April 7, 2020.
Virginia Mackay-Smith,
Associate Director.
[FR Doc. 2020–07662 Filed 4–10–20; 8:45 am]
BILLING CODE 4160–90–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Proposed Project
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Agency for Healthcare Research and
Quality
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Agency for Healthcare Research
and Quality, HHS.
AGENCY:
ACTION:
Notice.
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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:
‘‘Evaluating the Dissemination and
Implementation of PCOR to Increase
Referral, Enrollment, and Retention
through Automatic Referral to Cardiac
Rehabilitation (CR) with Care
Coordination.’’ This proposed
information collection was previously
published in the Federal Register on
February 4th, 2020 and allowed 60 days
for public comment. AHRQ did not
receive comments from members of 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 30 days after date of
publication of this notice.
ADDRESSES: Written comments and
recommendations for the proposed
information collection should be sent
within 30 days of publication of this
notice to www.reginfo.gov/public/do/
PRAMain. Find this particular
information collection by selecting
‘‘Currently under 30-day Review—Open
for Public Comments’’ or by using the
search function.
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:
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Evaluating the Dissemination and
Implementation of PCOR To Increase
Referral, Enrollment, and Retention
Through Automatic Referral to Cardiac
Rehabilitation (CR) With Care
Coordination
The aim of AHRQ’s TAKEheart
project is to (a) raise awareness about
the benefits of cardiac rehabilitation
(CR) after myocardial infarction or
coronary revascularization, then to (b)
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disseminate knowledge about the best
practices to increase referrals to CR,
and, finally, (c) to increase CR uptake.
Currently over two-thirds of eligible
cardiac patients are not referred to CR
despite extensive evidence of its
effectiveness in preventing subsequent
morbidity; national estimates of referral
range from 10–34%. To help improve
CR rates, the Million Hearts® Cardiac
Rehabilitation Collaborative—an
initiative co-led by the Centers for
Disease Control and Prevention (CDC)
and the Centers for Medicare &
Medicaid Services (CMS)—developed a
Cardiac Rehabilitation Change Package
(CRCP) and established a national goal
of 70% participation in CR by 2022 for
eligible patients. Recognizing that
widespread adoption of the CRCP could
help hospitals enhance CR rates, the
CDC turned to AHRQ with a request that
AHRQ consider disseminating and
implementing evidence for CR and
practices that promote CR. The CRCP is
designed to facilitate this dissemination
and implementation process. AHRQ
reviewed this request in the context of
its Patient Centered Outcomes Research
Dissemination and Implementation
initiative and judged the CDC
nomination to have a high level of fit
with AHRQ’s criteria of having a
substantial evidence base, high potential
impact, and high feasibility for wide
dissemination and implementation
Outreach with stakeholders indicates
that this initiative aligns well but does
not duplicate work by NIH; PCORI; CMS
and CDC.
The core recommendations in the
CDC package are, first to spread
adoption of automatic referral system—
where patients after cardiovascular
events are referred by the Electronic
Health Record to rehabilitation unless
the cardiologist actively decides not to
refer because of medical ineligibility.
The second core recommendation is use
of a care coordinator to guide patients
through referral has resulted in the most
significant increases in referral to CR.
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13APN1
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Federal Register / Vol. 85, No. 71 / Monday, April 13, 2020 / Notices
TAKEheart will facilitate dissemination
and implementation of Automatic
Referral with Care Coordination in
selected, diverse hospitals nationwide
which demonstrate their readiness.
AHRQ will evaluate TAKEheart to
assess:
• The extent and effectiveness of the
dissemination and implementation
efforts;
• the uptake and usage of Automatic
Referral with Care Coordination; and
• levels of referral to CR at the end of
the intervention.
Evaluation results will be used to
improve the intervention and to provide
guidance for future AHRQ
Dissemination and Implementation
projects. Two cohorts of ‘‘Partner
Hospitals,’’ up to 125 hospitals in total,
will receive training that disseminates
the importance of CR and ways to
enhance CR referral and then engages
them in efforts to implement Automatic
Referral with Care Coordination over
twelve month periods. The evaluation
will ascertain the diversity of hospitals
engaged, the activities that contributed
to (or hindered) their efforts, and the
types of support which they report
having been most (and least) useful.
This information will be used to
improve recruitment, technical
assistance, and tools for the second
cohort.
In addition, hospitals—including
those involved in the dissemination and
implementation support for Partner
Hospitals—will be invited to attend
Affinity Group virtual meetings
organized around specific topics of
interest which are not intrinsic to
Automatic Referral with Care
Coordination. Hospital staff engaged in
Affinity Groups will create a vibrant
Learning Community. The evaluation
will determine which Affinity Groups
engaged the most participants of the
Learning Community, and which
resources participants determined the
most useful. This information will be
used to develop resources which will be
available on a new, permanent website
dedicated to improving CR.
This study is being conducted by
AHRQ through its contractor, Abt
Associates Inc., pursuant to AHRQ’s
statutory authority to disseminate
government-funded research relevant to
comparative clinical effectiveness
research. 42 U.S.C. 299b–37(a).
Method of Data Collection
To collect data on the many facets of
the intervention, we will use multiple
data collection tools, each of which has
a specific purpose and set of
respondents.
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1. Partner Hospital Champion Survey.
Each Partner Hospital will designate a
‘‘Champion,’’ who will coordinate
activities associated with implementing
Automatic Referral with Care
Coordination at the hospital, and
provide the Champion’s name and email
address. The Champion may have any
role in the hospital, although they are
expected in relevant positions, such as
cardiologists or quality improvement
managers. We will conduct online
surveys of 125 Champions (one
Champion per hospital). We will use the
email addresses to send the Champion
a survey at two points: Seven months
after the start of dissemination and
implementation to the Partner Hospitals
and at the end of the 12-month
dissemination and implementation
period. The first survey will focus on
four constructs. First, it will capture
data about the hospital context, such as
whether it had prior experience
customizing an electronic medical
record (EMR) or is a safety net hospital.
Second, it will address the hospital’s
decision to participate in TAKEheart.
Third, it will capture data on the CR
programs the hospital refers to, whether
the number or type has changed, and
why. Fourth, it will collect feedback on
the training and technical assistance
received. The second survey will focus
on three constructs. First, it will collect
feedback on the TAKEheart
components, including training,
technical assistance, and use of the
website. Second, we will ask about the
hospitals’ response to participating in
TAKEheart, such as changes to referral
workflow or CR programs. Third, we
will ask those Partner Hospitals which
have not completed the process of
implementing Automatic Referral with
Care Coordination whether they
anticipate continuing to work towards
that goal and their confidence in
succeeding.
2. Partner Hospital Interviews.
a. Interviews with Partner Hospital
Champions. We will select, from each
cohort, eight Partner Hospitals that
demonstrated a strong interest in
addressing underserved populations or
reducing disparities in participation in
cardiac rehabilitation. We will conduct
a key informant interview with the
Champion of each selected Partner
Hospital to delve into their response to
the information and guidance that was
disseminated to them and to describe
how they are addressing the needs of
underserved populations by
implementing Automatic Referral with
Care Coordination.
b. Interviews with Partner Hospital
cardiologists. We will select, from each
cohort, eight hospitals based on criteria
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such as hospitals which serve specific
populations, or have the same EMRs,
which will inform their experience
customizing the EMR. We will conduct
semi-structured interviews with one
cardiologist at each of the selected
hospitals twice. In the second month of
the cohort for dissemination and
implementation, we will ask about their
needs, concerns, and expectations of the
program. In the 11th month of the
cohort implementation, we will
determine whether their concerns were
addressed appropriately and adequately.
c. Interviews with Partner Hospitals
that withdraw. We expect that a small
number of Partner Hospitals may
withdraw from the cohort. We will
identify these hospitals by their lack of
participation in training and technical
assistance events; technical assistance
providers will confirm their withdrawal.
We will interview up to nine
withdrawing hospitals to better
understand the reason for withdrawal
(e.g., a merger resulted in a loss of
support for the intervention, Champion
left), as well as facilitators of, and
barriers to, each hospital’s approach to
implementing Automatic Referral with
Care Coordination. If more than nine
hospitals withdraw, we will cease
interviewing.
3. Learning Community Participant
Survey. We will conduct online surveys
of 250 currently active Learning
Community participants at two points
in time, in months 18 and 31 of the
project. We will administer the survey
by sending a link to an online survey to
email addresses entered by virtual
meeting participants during registration.
The email will describe the purpose of
the survey.
4. Learning Community Follow-up
Survey. We will conduct a brief online
survey with up to 15 Learning
Community participants following the
final virtual meeting for each of 10
Affinity Groups, to ascertain whether
the hospitals were able to act on what
they learned during the session. The
total sample will be 150 Learning
Community participants.
Estimated Annual Respondent Burden
Exhibit 1 presents estimates of the
reporting burden hours for the data
collection efforts. Time estimates are
based on prior experiences and what
can reasonably be requested of
participating health care organizations.
The number of respondents listed in
column A, Exhibit 1 reflects a projected
90% response rate for data collection
effort 1, and an 80% response rate for
efforts 3 and 4 below.
1. Partner Hospital Champion Survey.
We assumed 113 hospital champions
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Federal Register / Vol. 85, No. 71 / Monday, April 13, 2020 / Notices
will complete the survey based on a
90% response rate. It is expected to take
up to 45 minutes to complete for a total
of 169.5 hours to complete.
2. Partner Hospital Interviews. Indepth interviews will occur with select
Partner Hospital staff.
a. Interviews with Partner Hospital
Champions. We will have a single, 90
minute interview with eight Partner
Hospital Champions, in each cohort,
from Partner Hospitals that have a
common characteristic of particular
interest, for a total of 24 hours.
b. Interviews with Partner Hospital
cardiologists. We will hold individual,
up-to-30 minute interviews with eight
cardiologists, twice in each cohort, for a
total of 16 hours.
c. Interviews with Partner Hospitals
that withdraw. We will interview up to
nine withdrawing hospitals for no more
than 20 minutes to better understand
the reason for withdrawal as well as
facilitators and barriers, for a total of 2.7
hours.
3. Learning Community Participant
Survey. We assumed 200 Learning
Community participants will complete
the survey based on an 80% response
rate. It is expected to take up to 15
minutes to complete each survey for a
total of 100 hours.
4. Learning Community Follow-up
Survey. We will conduct a brief, up to
10 minute, online survey of participants
of each of just ten selected Affinity
Groups at two months after the virtual
meeting. We assumed 120 Learning
Community participants will complete
the survey based on an 80% response
rate. It is expected to take up to 15
minutes to complete each survey for a
total of 20.4 hours.
EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS
A.
Number of
respondents
Data collection method or project activity
B.
Number of
responses per
respondent
C.
Hours per
response
D.
Total burden
hours
1. Partner Hospital Champion Survey * ...........................................................
2a. Interviews with Partner Hospital Champions .............................................
2b. Interviews with Partner Hospital Cardiologists ..........................................
2c. Interviews with Partner Hospitals that withdraw ........................................
3. Learning Community Survey ** ....................................................................
4. Learning Community Follow-up Survey ** ...................................................
113
16
16
9
200
120
2
1
2
1
2
1
0.75
1.5
0.5
0.3
0.25
0.17
169.5
24.0
16.0
2.7
100.0
20.4
Total ..........................................................................................................
474
........................
........................
332.6
* Number of respondents (Column A) reflects a sample size assuming a 90% response rate for this data collection effort.
** Number of respondents (Column A) reflects a sample size assuming an 80% response rate for this data collection effort.
Exhibit 2, below, presents the
estimated annualized cost burden
associated with the respondents’ time to
participate in this research. We obtained
median hourly wage rates for relevant
occupations from the Bureau of Labor &
Statistics on ‘‘Occupational
Employment Statistics, May 2018
Occupation Profiles’’ found at the
following URL on October 1, 2019:
https://www.bls.gov/oes/current/oes_
stru.htm#15-0000. We assumed that half
the Partner Hospital Champions will be
cardiologists and half will be Quality
Improvement managers. We calculated
the hourly rate of $72.27 by averaging
the median hourly wage rate for
cardiologists ($96.58, occupation code
29–1069) and medical and health
services managers ($47.95, occupation
code 11–1141). The occupation of
medical and health services managers
has been used for quality improvement
staff in other AHRQ projects. The total
cost burden is estimated to be about
$21,497.
EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN
A.
Number of
respondents
Data collection method or project activity
B.
Total burden
hours
Average
hourly wage
rate
Total cost
burden
1. Partner Hospital Champion Survey * ...........................................................
2a. Interviews with Partner Hospital Champions .............................................
2b. Interviews with Partner Hospital Cardiologists ..........................................
2c. Interviews with Partner Hospitals that withdraw ........................................
3. Learning Community Survey ** ....................................................................
4. Learning Community Follow-up Survey ** ...................................................
113
16
16
9
200
120
169.5
24.0
16.0
2.7
100.0
20.4
$72.27
72.27
96.58
72.27
47.95
47.95
$12,250
1,734
1,545
195
4,795
978
Total ..........................................................................................................
474
332.6
........................
21,497
khammond on DSKJM1Z7X2PROD with NOTICES
* Number of respondents (Column A) reflects a sample size assuming a 90% response rate for this data collection effort.
** Number of respondents (Column A) reflects a sample size assuming an 80% response rate for this data collection effort.
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
VerDate Sep<11>2014
17:57 Apr 10, 2020
Jkt 250001
research and healthcare information
dissemination functions, including
whether the information will have
practical utility; (b) the accuracy of
AHRQ’s estimate of burden (including
hours and costs) of the proposed
collection(s) of information; (c) ways to
enhance the quality, utility, and clarity
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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
E:\FR\FM\13APN1.SGM
13APN1
Federal Register / Vol. 85, No. 71 / Monday, April 13, 2020 / Notices
request for OMB approval of the
proposed information collection. All
comments will become a matter of
public record.
Dated: April 7, 2020.
Virginia L. Mackay-Smith,
Associate Director.
[FR Doc. 2020–07661 Filed 4–10–20; 8:45 am]
BILLING CODE 4160–90–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
[Docket No. CDC–2020–0001; NIOSH–333]
Developing a Workplace Supported
Recovery Program: A Strategy for
Assisting Workers and Employers With
the Nation’s Opioid and Substance Use
Disorder Epidemics; Request for
Information; Extension of Comment
Period
Centers for Disease Control and
Prevention, HHS.
ACTION: Extension of comment period.
AGENCY:
On February 26, 2020, the
National Institute for Occupational
Safety and Health (NIOSH), within the
Center for Disease Control and
Prevention (CDC), opened a docket to
obtain public input on a NIOSH plan to
develop resources and conduct research
on the topic of workplace supported
recovery. Workplace supported recovery
programs (WSRPs) assist workers and
employers facing the nation’s crisis
related to the misuse of opioids and
other drugs, and related substance
disorders. Comments were to be
received by April 27, 2020. NIOSH is
extending the comment period to close
on July 27, 2020, to allow stakeholders
and other interested parties sufficient
time to respond.
DATES: The comment period for the
document published on February 26,
2020 (85 FR 11085), is extended.
Comments must be received by July 27,
2020.
ADDRESSES: You may submit written
comments, identified by docket
numbers CDC–2020–0001 and NIOSH–
333, by either of the following two
methods:
• Federal eRulemaking Portal: https://
www.regulations.gov. Follow the
instructions for submitting comments.
• Mail: National Institute for
Occupational Safety and Health, NIOSH
Docket Office, 1090 Tusculum Avenue,
MS C–34, Cincinnati, Ohio 45226–1998.
Instructions: All information received
in response to this notice must include
khammond on DSKJM1Z7X2PROD with NOTICES
SUMMARY:
VerDate Sep<11>2014
17:57 Apr 10, 2020
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the agency name and docket number
[CDC–2020–0001; NIOSH–333]. All
relevant comments received will be
posted without change to https://
www.regulations.gov, including any
personal information provided.
FOR FURTHER INFORMATION CONTACT: L.
Casey Chosewood, NIOSH, 1600 Clifton
Road NE; Mailstop V24–4, Atlanta, GA
30329; phone: 404–498–2483 (not a tollfree number); email: twh@cdc.gov.
SUPPLEMENTARY INFORMATION: NIOSH
published a request for information in
the Federal Register on February 26,
2020 (85 FR 11085) regarding the
planned development of resources and
conduct of research on the topic of
workplace supported recovery programs
(WSRPs). This notice announces the
extension of the comment period until
July 27, 2020.
John J. Howard,
Director, National Institute for Occupational
Safety and Health, Centers for Disease Control
and Prevention.
[FR Doc. 2020–07683 Filed 4–10–20; 8:45 am]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Community Living
Intent To Award a Single-Source
Supplement for the Amputee Coalition
of America, Inc. for the National Limb
Loss Resource Center Cooperative
Agreement
Notice; intent to award a singlesource supplement.
ACTION:
The Administration for
Community Living (ACL) announces the
intent to award a single-source
supplement to the current cooperative
agreement held by the Amputee
Coalition of America, Inc. for the
National Limb Loss Resource Center
(NLLRC). The purpose of this project is
to expand on current grant activities
occurring across communities. These
activities include programs that promote
independence, community living, and
the adoption of healthy behaviors that
promote wellness and prevent and/or
reduce chronic conditions associated
with limb loss and increase partnerships
and collaborations with ACL programs
that will benefit all people living with
limb loss or limb differences. The
administrative supplement for FY 2020
will be for $500,000, bringing the total
award for FY 2020 to $3,884,003.
FOR MORE INFORMATION CONTACT: For
further information or comments
regarding this program supplement,
contact Elizabeth Leef, U.S. Department
SUMMARY:
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20505
of Health and Human Services,
Administration for Community Living,
Administration on Disabilities,
Independent Living Administration at
(202) 475–2486 and; email
Elizabeth.leef@acl.hhs.gov.
SUPPLEMENTARY INFORMATION: The
additional funding will not be used to
begin new projects. The funding will be
used to enhance and expand existing
programs that can serve an increased
number of veterans and people living
with limb loss and limb differences by
providing increased technical assistance
activities; promoting health and
wellness programs; addressing
healthcare access issues, including
maternity care; promoting the adoption
of healthy behaviors with the objective
of preventing and/or reducing chronic
conditions associated with limb loss;
increasing partnerships and
collaborations with ACL programs that
will benefit all people living with limb
loss or limb differences; enhancing and
expanding the evaluation activities
currently under way; and enhancing
website capacities for improved
information dissemination.
Program Name: National Limb Loss
Resource Center
Recipient: The Amputee Coalition of
America, Inc.
Period of Performance: The
supplement award will be issued for the
second year of the five-year project
period of April 1, 2019, through March
29, 2024.
Total Supplement Award Amount:
$500,000 in FY 2020.
Award Type: Cooperative Agreement
Supplement.
Statutory Authority: This program is
authorized under Section 317 of the
Public Health Service Act (42 U.S.C.
247(b–4)); Consolidated and Further
Continuing Appropriations Act, 2015,
Public Law 113–235 (Dec. 16, 2014).
Basis for Award: The Amputee
Coalition of America, Inc. is currently
funded to carry out the objectives of this
program, entitled The National Limb
Loss Resource Center for the period of
April 1, 2019, through March 29, 2024.
Almost 2 million Americans have
experienced amputations or were born
with limb difference and another 28
million people in our country are at risk
for amputation. The supplement will
enable the grantee to carry their work
even further, serving more people living
with limb loss and/or limb differences
and providing even more
comprehensive training and technical
assistance in the development of longterm supportive services. The additional
funding will not be used to begin new
projects or activities. The NLLRC will
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]]>Agencies
[Federal Register Volume 85, Number 71 (Monday, April 13, 2020)]
[Notices]
[Pages 20502-20505]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-07661]
-----------------------------------------------------------------------
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: ``Evaluating the Dissemination and Implementation of PCOR to
Increase Referral, Enrollment, and Retention through Automatic Referral
to Cardiac Rehabilitation (CR) with Care Coordination.'' This proposed
information collection was previously published in the Federal Register
on February 4th, 2020 and allowed 60 days for public comment. AHRQ did
not receive comments from members of 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 30 days after date
of publication of this notice.
ADDRESSES: Written comments and recommendations for the proposed
information collection should be sent within 30 days of publication of
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function.
FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427-1477, or by email at
[email protected].
SUPPLEMENTARY INFORMATION:
Proposed Project
Evaluating the Dissemination and Implementation of PCOR To Increase
Referral, Enrollment, and Retention Through Automatic Referral to
Cardiac Rehabilitation (CR) With Care Coordination
The aim of AHRQ's TAKEheart project is to (a) raise awareness about
the benefits of cardiac rehabilitation (CR) after myocardial infarction
or coronary revascularization, then to (b) disseminate knowledge about
the best practices to increase referrals to CR, and, finally, (c) to
increase CR uptake. Currently over two-thirds of eligible cardiac
patients are not referred to CR despite extensive evidence of its
effectiveness in preventing subsequent morbidity; national estimates of
referral range from 10-34%. To help improve CR rates, the Million
Hearts[supreg] Cardiac Rehabilitation Collaborative--an initiative co-
led by the Centers for Disease Control and Prevention (CDC) and the
Centers for Medicare & Medicaid Services (CMS)--developed a Cardiac
Rehabilitation Change Package (CRCP) and established a national goal of
70% participation in CR by 2022 for eligible patients. Recognizing that
widespread adoption of the CRCP could help hospitals enhance CR rates,
the CDC turned to AHRQ with a request that AHRQ consider disseminating
and implementing evidence for CR and practices that promote CR. The
CRCP is designed to facilitate this dissemination and implementation
process. AHRQ reviewed this request in the context of its Patient
Centered Outcomes Research Dissemination and Implementation initiative
and judged the CDC nomination to have a high level of fit with AHRQ's
criteria of having a substantial evidence base, high potential impact,
and high feasibility for wide dissemination and implementation Outreach
with stakeholders indicates that this initiative aligns well but does
not duplicate work by NIH; PCORI; CMS and CDC.
The core recommendations in the CDC package are, first to spread
adoption of automatic referral system--where patients after
cardiovascular events are referred by the Electronic Health Record to
rehabilitation unless the cardiologist actively decides not to refer
because of medical ineligibility. The second core recommendation is use
of a care coordinator to guide patients through referral has resulted
in the most significant increases in referral to CR.
[[Page 20503]]
TAKEheart will facilitate dissemination and implementation of Automatic
Referral with Care Coordination in selected, diverse hospitals
nationwide which demonstrate their readiness.
AHRQ will evaluate TAKEheart to assess:
The extent and effectiveness of the dissemination and
implementation efforts;
the uptake and usage of Automatic Referral with Care
Coordination; and
levels of referral to CR at the end of the intervention.
Evaluation results will be used to improve the intervention and to
provide guidance for future AHRQ Dissemination and Implementation
projects. Two cohorts of ``Partner Hospitals,'' up to 125 hospitals in
total, will receive training that disseminates the importance of CR and
ways to enhance CR referral and then engages them in efforts to
implement Automatic Referral with Care Coordination over twelve month
periods. The evaluation will ascertain the diversity of hospitals
engaged, the activities that contributed to (or hindered) their
efforts, and the types of support which they report having been most
(and least) useful. This information will be used to improve
recruitment, technical assistance, and tools for the second cohort.
In addition, hospitals--including those involved in the
dissemination and implementation support for Partner Hospitals--will be
invited to attend Affinity Group virtual meetings organized around
specific topics of interest which are not intrinsic to Automatic
Referral with Care Coordination. Hospital staff engaged in Affinity
Groups will create a vibrant Learning Community. The evaluation will
determine which Affinity Groups engaged the most participants of the
Learning Community, and which resources participants determined the
most useful. This information will be used to develop resources which
will be available on a new, permanent website dedicated to improving
CR.
This study is being conducted by AHRQ through its contractor, Abt
Associates Inc., pursuant to AHRQ's statutory authority to disseminate
government-funded research relevant to comparative clinical
effectiveness research. 42 U.S.C. 299b-37(a).
Method of Data Collection
To collect data on the many facets of the intervention, we will use
multiple data collection tools, each of which has a specific purpose
and set of respondents.
1. Partner Hospital Champion Survey. Each Partner Hospital will
designate a ``Champion,'' who will coordinate activities associated
with implementing Automatic Referral with Care Coordination at the
hospital, and provide the Champion's name and email address. The
Champion may have any role in the hospital, although they are expected
in relevant positions, such as cardiologists or quality improvement
managers. We will conduct online surveys of 125 Champions (one Champion
per hospital). We will use the email addresses to send the Champion a
survey at two points: Seven months after the start of dissemination and
implementation to the Partner Hospitals and at the end of the 12-month
dissemination and implementation period. The first survey will focus on
four constructs. First, it will capture data about the hospital
context, such as whether it had prior experience customizing an
electronic medical record (EMR) or is a safety net hospital. Second, it
will address the hospital's decision to participate in TAKEheart.
Third, it will capture data on the CR programs the hospital refers to,
whether the number or type has changed, and why. Fourth, it will
collect feedback on the training and technical assistance received. The
second survey will focus on three constructs. First, it will collect
feedback on the TAKEheart components, including training, technical
assistance, and use of the website. Second, we will ask about the
hospitals' response to participating in TAKEheart, such as changes to
referral workflow or CR programs. Third, we will ask those Partner
Hospitals which have not completed the process of implementing
Automatic Referral with Care Coordination whether they anticipate
continuing to work towards that goal and their confidence in
succeeding.
2. Partner Hospital Interviews.
a. Interviews with Partner Hospital Champions. We will select, from
each cohort, eight Partner Hospitals that demonstrated a strong
interest in addressing underserved populations or reducing disparities
in participation in cardiac rehabilitation. We will conduct a key
informant interview with the Champion of each selected Partner Hospital
to delve into their response to the information and guidance that was
disseminated to them and to describe how they are addressing the needs
of underserved populations by implementing Automatic Referral with Care
Coordination.
b. Interviews with Partner Hospital cardiologists. We will select,
from each cohort, eight hospitals based on criteria such as hospitals
which serve specific populations, or have the same EMRs, which will
inform their experience customizing the EMR. We will conduct semi-
structured interviews with one cardiologist at each of the selected
hospitals twice. In the second month of the cohort for dissemination
and implementation, we will ask about their needs, concerns, and
expectations of the program. In the 11th month of the cohort
implementation, we will determine whether their concerns were addressed
appropriately and adequately.
c. Interviews with Partner Hospitals that withdraw. We expect that
a small number of Partner Hospitals may withdraw from the cohort. We
will identify these hospitals by their lack of participation in
training and technical assistance events; technical assistance
providers will confirm their withdrawal. We will interview up to nine
withdrawing hospitals to better understand the reason for withdrawal
(e.g., a merger resulted in a loss of support for the intervention,
Champion left), as well as facilitators of, and barriers to, each
hospital's approach to implementing Automatic Referral with Care
Coordination. If more than nine hospitals withdraw, we will cease
interviewing.
3. Learning Community Participant Survey. We will conduct online
surveys of 250 currently active Learning Community participants at two
points in time, in months 18 and 31 of the project. We will administer
the survey by sending a link to an online survey to email addresses
entered by virtual meeting participants during registration. The email
will describe the purpose of the survey.
4. Learning Community Follow-up Survey. We will conduct a brief
online survey with up to 15 Learning Community participants following
the final virtual meeting for each of 10 Affinity Groups, to ascertain
whether the hospitals were able to act on what they learned during the
session. The total sample will be 150 Learning Community participants.
Estimated Annual Respondent Burden
Exhibit 1 presents estimates of the reporting burden hours for the
data collection efforts. Time estimates are based on prior experiences
and what can reasonably be requested of participating health care
organizations. The number of respondents listed in column A, Exhibit 1
reflects a projected 90% response rate for data collection effort 1,
and an 80% response rate for efforts 3 and 4 below.
1. Partner Hospital Champion Survey. We assumed 113 hospital
champions
[[Page 20504]]
will complete the survey based on a 90% response rate. It is expected
to take up to 45 minutes to complete for a total of 169.5 hours to
complete.
2. Partner Hospital Interviews. In-depth interviews will occur with
select Partner Hospital staff.
a. Interviews with Partner Hospital Champions. We will have a
single, 90 minute interview with eight Partner Hospital Champions, in
each cohort, from Partner Hospitals that have a common characteristic
of particular interest, for a total of 24 hours.
b. Interviews with Partner Hospital cardiologists. We will hold
individual, up-to-30 minute interviews with eight cardiologists, twice
in each cohort, for a total of 16 hours.
c. Interviews with Partner Hospitals that withdraw. We will
interview up to nine withdrawing hospitals for no more than 20 minutes
to better understand the reason for withdrawal as well as facilitators
and barriers, for a total of 2.7 hours.
3. Learning Community Participant Survey. We assumed 200 Learning
Community participants will complete the survey based on an 80%
response rate. It is expected to take up to 15 minutes to complete each
survey for a total of 100 hours.
4. Learning Community Follow-up Survey. We will conduct a brief, up
to 10 minute, online survey of participants of each of just ten
selected Affinity Groups at two months after the virtual meeting. We
assumed 120 Learning Community participants will complete the survey
based on an 80% response rate. It is expected to take up to 15 minutes
to complete each survey for a total of 20.4 hours.
Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
B. Number of
Data collection method or project activity A. Number of responses per C. Hours per D. Total
respondents respondent response burden hours
----------------------------------------------------------------------------------------------------------------
1. Partner Hospital Champion Survey *........... 113 2 0.75 169.5
2a. Interviews with Partner Hospital Champions.. 16 1 1.5 24.0
2b. Interviews with Partner Hospital 16 2 0.5 16.0
Cardiologists..................................
2c. Interviews with Partner Hospitals that 9 1 0.3 2.7
withdraw.......................................
3. Learning Community Survey **................. 200 2 0.25 100.0
4. Learning Community Follow-up Survey **....... 120 1 0.17 20.4
---------------------------------------------------------------
Total....................................... 474 .............. .............. 332.6
----------------------------------------------------------------------------------------------------------------
* Number of respondents (Column A) reflects a sample size assuming a 90% response rate for this data collection
effort.
** Number of respondents (Column A) reflects a sample size assuming an 80% response rate for this data
collection effort.
Exhibit 2, below, presents the estimated annualized cost burden
associated with the respondents' time to participate in this research.
We obtained median hourly wage rates for relevant occupations from the
Bureau of Labor & Statistics on ``Occupational Employment Statistics,
May 2018 Occupation Profiles'' found at the following URL on October 1,
2019: https://www.bls.gov/oes/current/oes_stru.htm#15-0000. We assumed
that half the Partner Hospital Champions will be cardiologists and half
will be Quality Improvement managers. We calculated the hourly rate of
$72.27 by averaging the median hourly wage rate for cardiologists
($96.58, occupation code 29-1069) and medical and health services
managers ($47.95, occupation code 11-1141). The occupation of medical
and health services managers has been used for quality improvement
staff in other AHRQ projects. The total cost burden is estimated to be
about $21,497.
Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
A. Number of B. Total Average hourly Total cost
Data collection method or project activity respondents burden hours wage rate burden
----------------------------------------------------------------------------------------------------------------
1. Partner Hospital Champion Survey *........... 113 169.5 $72.27 $12,250
2a. Interviews with Partner Hospital Champions.. 16 24.0 72.27 1,734
2b. Interviews with Partner Hospital 16 16.0 96.58 1,545
Cardiologists..................................
2c. Interviews with Partner Hospitals that 9 2.7 72.27 195
withdraw.......................................
3. Learning Community Survey **................. 200 100.0 47.95 4,795
4. Learning Community Follow-up Survey **....... 120 20.4 47.95 978
---------------------------------------------------------------
Total....................................... 474 332.6 .............. 21,497
----------------------------------------------------------------------------------------------------------------
* Number of respondents (Column A) reflects a sample size assuming a 90% response rate for this data collection
effort.
** Number of respondents (Column A) reflects a sample size assuming an 80% response rate for this data
collection effort.
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
healthcare information dissemination functions, including whether the
information will have practical utility; (b) the accuracy of AHRQ's
estimate of burden (including hours and costs) of the proposed
collection(s) of information; (c) ways to enhance the quality, utility,
and clarity of the information to be collected; and (d) ways to
minimize the burden of the collection of information upon the
respondents, including the use of 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
[[Page 20505]]
request for OMB approval of the proposed information collection. All
comments will become a matter of public record.
Dated: April 7, 2020.
Virginia L. Mackay-Smith,
Associate Director.
[FR Doc. 2020-07661 Filed 4-10-20; 8:45 am]
BILLING CODE 4160-90-P
