Agency Information Collection Activities: Proposed Collection; Comment Request, 76621-76624 [2022-27175]
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Federal Register / Vol. 87, No. 240 / Thursday, December 15, 2022 / Notices
application provides EXIM Bank with
the credit information on a foreign
buyer credit limit request needed to
make a determination of eligibility for
EXIM Bank support in adherence to
legislatively required reasonable
reassurance of repayment and other
statutory requirements. The application
can be reviewed at: https://
img.exim.gov/s3fs-public/pub/pending/
eib-92-51.pdf. Application for Special
Buyer Credit Limit (SBCL) Under MultiBuyer Export Credit Insurance Policies.
DATES: Comments should be received on
or before February 13, 2023 to be
assured of consideration.
ADDRESSES: Comments may be
submitted electronically on
WWW.REGULATIONS.GOV or by mail
to Ms. Risa Pickle, Export-Import Bank
of the United States, 811 Vermont Ave.
NW, Washington, DC 20571.
SUPPLEMENTARY INFORMATION:
Titles and Form Number: EIB 92–51
Application for Special Buyer Credit
Limit (SBCL) Under Multi-Buyer Export
Credit Insurance Policies.
OMB Number: 3048–0015.
Type of Review: Regular.
Need and Use: This application
provides EXIM Bank with the credit
information on a foreign buyer credit
limit request needed to make a
determination of eligibility for EXIM
Bank support in adherence to
legislatively required reasonable
reassurance of repayment and other
statutory requirements.
The changes to this form are intended
to improve the sequence and layout of
the foreign buyer credit questions and
add description of the drop-down
menus.
Affected Public: This form affects
business entities involved in the export
of U.S. goods and services. The
estimated number of respondents and
the annual hour burden has been
lowered to only count the new
applicants. The estimate of the overall
burden to the public has been reduced
after considering that EXIM
automatically processes renewals of
Special Buyer Credit Limit requests in
the Exim Online (EOL) system, and,
thus, the renewing policyholders don’t
have to manually complete an
application.
The number of respondents: 2,000.
Estimated time per respondents: 30
minutes.
The frequency of response: As
needed.
Annual hour burden: 1,000 total
hours.
Government Expenses:
Reviewing time per hour: 1 hour.
Responses per year: 2,000.
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Reviewing time per year: 2,000 hours.
Average Wages per hour: $42.50.
Average cost per year (time * wages):
$ 85,000.
Benefits and overhead: 20%.
Total Government Cost: $ 102,000.
Andy Chang,
Director, IT Records Management, Agency
Clearance Officer, Office of the Chief
Information Officer.
[FR Doc. 2022–27165 Filed 12–14–22; 8:45 am]
BILLING CODE 6690–01–P
FEDERAL DEPOSIT INSURANCE
CORPORATION
Sunshine Act Meetings
11:28 a.m. on Tuesday,
December 13, 2022.
TIME AND DATE:
The meeting was held in the
Board Room located on the sixth floor
of the FDIC Building located at 550 17th
Street NW, Washington, DC.
PLACE:
STATUS:
Closed.
The Board
of Directors of the Federal Deposit
Insurance Corporation met to consider
matters related to the Corporation’s
supervision, corporate, and resolution
activities. In calling the meeting, the
Board determined, on motion of
Director Rohit Chopra (Director,
Consumer Financial Protection Bureau),
seconded by, Director Michael J. Hsu
(Acting Comptroller of the Currency)
and concurred in by Acting Chairman
Martin J. Gruenberg, that the public
interest did not require consideration of
the matters in a meeting open to public
observation; and that the matters could
be considered in a closed meeting by
authority of subsections (c)(2), (c)(4),
(c)(6), (c)(8), (c)(9)(A)(ii), and (c)(9)(B) of
the ‘‘Government in the Sunshine Act’’
(5 U.S.C. 552b(c)(2), (c)(4), (c)(6), (c)(8),
(c)(9)(A)(ii), and (c)(9)(B)).
MATTERS TO BE CONSIDERED:
CONTACT PERSON FOR MORE INFORMATION:
Requests for further information
concerning the meeting may be directed
to Debra A. Decker, Executive Secretary
of the Corporation, at 202–898–8748.
Dated this the 13th day of December, 2022.
Federal Deposit Insurance Corporation.
James P. Sheesley,
Assistant Executive Secretary.
[FR Doc. 2022–27355 Filed 12–13–22; 4:15 pm]
BILLING CODE 6714–01–P
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76621
FEDERAL MARITIME COMMISSION
[Docket No. 22–23]
Marine Transport Logistics, Inc.,
Complainant v. CMA–CGM (America),
LLC, and CMA–CGM S.A Respondents;
Notice of Filing of Complaint and
Assignment
Served: December 9, 2022.
Notice is given that a Verified
Amended Complaint has been filed with
the Federal Maritime Commission
(Commission) by Marine Transport
Logistics, Inc., hereinafter
‘‘Complainant,’’ against CMA–CGM
(America), Inc. and CMA–CGM S.A.,
hereinafter ‘‘Respondents.’’
Complainant states that it is a nonvessel-operating common carrier
organized under the laws of the State of
New York. Complainant identifies
CMA–CGM S.A. as a vessel-operating
common carrier (VOCC) based in
France, and CMA–CGM (America) LLC
as the VOCC’s agent in the United States
with offices in New Jersey and Virginia.
Complainant alleges that Respondents
violated 46 U.S.C. 41102(c) in its
practices regarding the shipment of
Complainant’s container cargo and the
charges incurred as a result. The full
text of the complaint can be found in
the Commission’s Electronic Reading
Room at https://www2.fmc.gov/
readingroom/proceeding/22-23/.
This proceeding has been assigned to
Office of Administrative Law Judges.
The initial decision of the presiding
officer in this proceeding shall be issued
by September 7, 2023, and the final
decision of the Commission shall be
issued by March 21, 2024.
William Cody,
Secretary.
[FR Doc. 2022–27160 Filed 12–14–22; 8:45 am]
BILLING CODE 6730–02–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Agency for Healthcare Research and
Quality
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Agency for Healthcare Research
and Quality, HHS.
ACTION: Notice.
AGENCY:
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
SUMMARY:
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Federal Register / Vol. 87, No. 240 / Thursday, December 15, 2022 / Notices
information collection project ‘‘The
AHRQ Safety Program for Telemedicine:
Improving the Diagnostic Process and
Improving Antibiotic Use.’’
DATES: Comments on this notice must be
received by February 13, 2023.
ADDRESSES: Written comments should
be submitted to: Doris Lefkowitz,
Reports Clearance Officer, AHRQ, by
email at doris.lefkowitz@AHRQ.hhs.gov.
Copies of the proposed collection
plans, data collection instruments, and
specific details on the estimated burden
can be obtained from the AHRQ Reports
Clearance Officer.
FOR FURTHER INFORMATION CONTACT:
Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427–1477, or by
email at doris.lefkowitz@AHRQ.hhs.gov.
SUPPLEMENTARY INFORMATION:
lotter on DSK11XQN23PROD with NOTICES1
Proposed Project
The AHRQ Safety Program for
Telemedicine: Improving the Diagnostic
Process and Improving Antibiotic Use
Telemedicine visits increased
dramatically in response to the COVID–
19 pandemic and resulting changes in
third-party payer reimbursement
policies. Telemedicine visits increased
from 0.3 percent of all ambulatory visits
in 2019 to 23.6 percent by Spring 2020.
Given this rapid growth, the need to
ensure safe and appropriate patient care
in this setting is urgent. Telemedicine
has many benefits, such as facilitating
continuity of care; improving access
beyond normal hours; reducing patients’
travel burden; overcoming health care
provider (HCP) shortages; and providing
support for patients managing chronic
health conditions. However, transferring
clinical practices from an in-person to a
virtual environment poses potential
risks. Many HCPs have never received
formal training in using telemedicine
effectively to diagnose and treat patients
virtually. Additionally, inadequate
internet access, which
disproportionately impacts rural and
minority populations, and struggles
accessing telemedicine platforms may
force video-based telemedicine visits to
transition to audio-only or be skipped.
This program aims to improve two atrisk areas among telemedicine practices
by implementing the AHRQ- and Johns
Hopkins Armstrong Institute for Patient
Safety and Quality (JHAI)-developed
Comprehensive Unit-based Safety
Program (CUSP) approach: (1) the
diagnostic process for breast, colorectal,
and lung cancer; and (2) antibiotic
stewardship (AS). The CUSP approach
improves safety culture at the practice
level, enables harm prevention, and
engages providers who are on the front
lines while integrating technical and
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adaptive/cultural approaches to making
sustainable changes.
This program constitutes the first
large-scale implementation of a quality
improvement effort for the cancer
diagnostic process and AS in
telemedicine. These areas were chosen
given the need for clearer guidance and
evidence-based telemedicine practices
for clinicians and potential for positive
impact on outcomes. This program will
incorporate CUSP strategies to improve
the diagnostic process for breast,
colorectal, and lung cancer and to
improve antibiotic prescribing in
telemedicine. The program goals are to:
• Identify best practices in
implementing interventions to improve
the cancer diagnostic process and AS in
telemedicine.
• Determine how best to adapt CUSP
to enhance the cancer diagnostic
process and AS in telemedicine.
This study is being conducted by
AHRQ through its contractor, NORC at
the University of Chicago (NORC) and
NORC’s subcontractors, the Johns
Hopkins Armstrong Institute of Patient
Safety and Quality (JHAI) and Baylor
College of Medicine (Baylor), 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 value of
healthcare services and with respect to
quality measurement and improvement.
42 U.S.C. 299a(a)(1) and (2)
Method of Collection
To achieve the goals of the AHRQ
Safety Program for Telemedicine
(‘‘Safety Program’’), primary and
secondary data collection activities will
include:
(1) Structural Assessment: A brief
online assessment will be completed by
a leader/champion from each practice to
understand practices’ infrastructure and
capacity to implement the Safety
Program.
(2) AHRQ Office Readiness Survey: A
brief online Office Readiness Survey
will be completed by all participating
staff from each practice in the cancer
diagnostic process cohort to understand
practices’ readiness for implementation
of the Safety Program.
(3) The AHRQ Surveys on Patient
Safety Culture: The Medical Office
Survey on Patient Safety Culture
(MOSOPS) (both cohorts) and a
Diagnostic Safety Supplement (cancer
diagnostic process cohort only) will be
completed by all participating staff to
assess patient safety issues, medical
errors, and event reporting practices.
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(4) Participant Experience Survey: A
brief online assessment will be
completed by a leader/champion from
each practice to assess how practices
approached implementation of the
Safety Program.
(5) Semi-Structured Qualitative
Interviews: A proportion of practices
from both cohorts will be selected to
participate in telephone/virtual
discussions to understand the
facilitators and barriers to implementing
the Safety Program.
(6) Clinical Data Collection Form:
Practices in the cancer diagnostic
process cohort will complete a Clinical
Data Collection Form for patients
suspected of having breast, colorectal, or
lung cancer.
(7) Electronic Health Record (EHR)
Data: Practice-level antibiotic usage and
clinical outcomes data will be extracted
from the EHRs of practices in the AS
cohort.
This data collection effort will be part
of a comprehensive evaluation strategy
to assess the adoption of the Safety
Program among telemedicine practices
comprising the cancer diagnostic
process and AS cohorts; measure the
effectiveness of the Safety Program
among the participating practices and
evaluate how providers experienced the
program as well as the perceived
usefulness of the Safety Program’s
education materials and metrics; and
understand drivers of antibiotic
prescribing among practices in the AS
cohort and drivers of timely diagnosis
for patients suspected of having breast,
colorectal, or lung cancer among
practices in the cancer diagnostic
process cohort.
The evaluation is largely formative in
nature as AHRQ seeks information on
the implementation and effectiveness of
CUSP in a novel setting—telemedicine.
The evaluation will utilize a pre-post
design, comparing data collected at
baseline and at the end of the Safety
Program within each cohort.
Estimated Annual Respondent Burden
Exhibit A.1 shows the estimated
annualized burden hours for the
respondents’ time to complete the
structural assessments, AHRQ office
readiness and patient safety culture
surveys, participant experience surveys,
semi-structured qualitative interviews,
clinical data collection instrument
(collected for 3 patients monthly and
submitted quarterly), and EHR data
extractions (collected monthly and
submitted quarterly). Data will be
collected from up to 300 practices
providing telemedicine for the cancer
diagnostic process cohort and from up
to 500 practices providing telemedicine
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Federal Register / Vol. 87, No. 240 / Thursday, December 15, 2022 / Notices
for the AS cohort. For the three-year
clearance period, the estimated
annualized burden hours for the data
collection activities are 5,570.
EXHIBIT A.1—ESTIMATED ANNUALIZED BURDEN HOURS
Number of
respondents *
Form name
1. Structural Assessments (both cohorts) .......................................................
2. AHRQ Office Readiness Survey (cancer diagnostic process cohort only)
3. AHRQ Patient Safety Culture Surveys:
a. MOSOPS (both cohorts) ......................................................................
b. Diagnostic Safety Supplement (cancer diagnostic process cohort
only) ......................................................................................................
4. Participant Experience Survey (both cohorts):
a. Cancer diagnostic process cohort survey ............................................
b. AS cohort survey ..................................................................................
5. Semi-structured qualitative interviews (both cohorts) .................................
6. Clinical Data Collection Form (cancer diagnostic process cohort) .............
7. HER data (AS cohort) .................................................................................
Total ..........................................................................................................
Number of
responses per
respondent
Hours per
response
Total
burden hours
200
350
2
1
0.2
0.1
80
35
933
2
0.5
933
350
2
0.2
140
75
125
24
90
150
1
1
1
54
18
0.17
0.33
1
0.33
1
13
41
24
1,604
2,700
........................
........................
........................
5,570
* Annualized number of respondents is based on maximum practices recruited and 75% response rate for forms 1 and 4a and 4b, 50% response rate for forms 2, 3a and 3b, and 90% response rate for forms 5–7.
Exhibit A.2 shows the estimated
annualized cost burden based on the
respondents’ time to complete the data
collection forms. The total cost burden
is estimated to be $576,922.
EXHIBIT A.2—ESTIMATED ANNUALIZED COST BURDEN
Number of
respondents *
Form name
Total
burden hours
Average
hourly wage
rate **
Total
burden cost
1. Structural Assessments (both cohorts) .......................................................
2. AHRQ Office Readiness Survey (cancer diagnostic process cohort only)
3. AHRQ Patient Safety Culture Surveys:
a. MOSOPS (both cohorts):
i. Physicians ......................................................................................
ii. Other Health Practitioners .............................................................
b. Diagnostic Safety Supplement (cancer diagnostic process cohort
only):
i. Physicians ......................................................................................
ii. Other Health Practitioners .............................................................
4. Participant Experience Survey (both cohorts) .............................................
5. Semi-structured qualitative interviews (both cohorts) .................................
6. Clinical Data Collection Form (cancer diagnostic process cohort only) .....
7. EHR data (AS cohort only) ..........................................................................
200
350
80
35
a $111.30
466
467
466
467
a 111.30
175
175
200
24
90
150
70
70
54
24
1,604
2,700
a 111.30
a 111.30
7,791
2,183
6,010
2,671
178,525
300,510
Total ..........................................................................................................
3,497
5,582
........................
576,922
a 111.30
b 31.19
b 31.19
a 111.30
a 111.30
a 111.30
$8,904
3,896
51,866
14,566
* Annualized number of respondents is based on maximum practices recruited and 75% response rate for forms 1 and 4, 50% response rate
for forms 2, 3a and 3b, and 90% response rate for forms 5–7.
** National Compensation Survey: Occupational wages in the United States May 2021 ‘‘U.S. Department of Labor, Bureau of Labor Statistics:’’
https://www.bls.gov/oes/current/oes_stru.htm#29-0000.
a Based on the mean wages for 29–1069 Physicians and Surgeons, All Other.
b Based on the mean wages for 29–9099 Miscellaneous Health Practitioners and Technical Workers: Healthcare Practitioners and Technical
Workers, All Other.
lotter on DSK11XQN23PROD with NOTICES1
Request for Comments
In accordance with the Paperwork
Reduction Act, 44 U.S.C. 3501–3520,
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’s health care research and health
care information dissemination
functions, including whether the
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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.
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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.
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Federal Register / Vol. 87, No. 240 / Thursday, December 15, 2022 / Notices
Dated: December 9, 2022.
Marquita Cullom,
Associate Director.
[FR Doc. 2022–27175 Filed 12–14–22; 8:45 am]
BILLING CODE 4160–90–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier CMS–R–5 & CMS–
10146]
Agency Information Collection
Activities: Submission for OMB
Review; Comment Request
Centers for Medicare &
Medicaid Services, Health and Human
Services (HHS).
ACTION: Notice.
AGENCY:
The Centers for Medicare &
Medicaid Services (CMS) is announcing
an opportunity for the public to
comment on CMS’ intention to collect
information from the public. Under the
Paperwork Reduction Act of 1995
(PRA), federal agencies are required to
publish notice in the Federal Register
concerning each proposed collection of
information, including each proposed
extension or reinstatement of an existing
collection of information, and to allow
a second opportunity for public
comment on the notice. Interested
persons are invited to send comments
regarding the burden estimate or any
other aspect of this collection of
information, including the necessity and
utility of the proposed information
collection for the proper performance of
the agency’s functions, the accuracy of
the estimated burden, ways to enhance
the quality, utility, and clarity of the
information to be collected, and the use
of automated collection techniques or
other forms of information technology to
minimize the information collection
burden.
SUMMARY:
Comments on the collection(s) of
information must be received by the
OMB desk officer by January 17, 2023.
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.
To obtain copies of a supporting
statement and any related forms for the
proposed collection(s) summarized in
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DATES:
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this notice, please access the CMS PRA
website by copying and pasting the
following web address into your web
browser: https://www.cms.gov/
Regulations-and-Guidance/Legislation/
PaperworkReductionActof1995/PRAListing.
FOR FURTHER INFORMATION CONTACT:
William Parham at (410) 786–4669.
SUPPLEMENTARY INFORMATION: Under the
Paperwork Reduction Act of 1995 (PRA)
(44 U.S.C. 3501–3520), federal agencies
must obtain approval from the Office of
Management and Budget (OMB) for each
collection of information they conduct
or sponsor. The term ‘‘collection of
information’’ is defined in 44 U.S.C.
3502(3) and 5 CFR 1320.3(c) and
includes agency requests or
requirements that members of the public
submit reports, keep records, or provide
information to a third party. Section
3506(c)(2)(A) of the PRA (44 U.S.C.
3506(c)(2)(A)) requires federal agencies
to publish a 30-day notice in the
Federal Register concerning each
proposed collection of information,
including each proposed extension or
reinstatement of an existing collection
of information, before submitting the
collection to OMB for approval. To
comply with this requirement, CMS is
publishing this notice that summarizes
the following proposed collection(s) of
information for public comment:
1. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Physician
Certifications/Recertifications in Skilled
Nursing Facilities Manual Instruction;
Use: Section 1814(a) of the Social
Security Act (the Act) requires specific
certifications in order for Medicare
payments to be made for certain
services. Before the enactment of the
Omnibus Budget Reconciliation Act of
1989 (OBRA1989, Pub. L. 101–239),
section 1814(a)(2) of the Act required
that, in the case of posthospital
extended care services, a physician
certify that the services are or were
required to be given because the
individual needs or needed, on a daily
basis, skilled nursing care (provided
directly by or requiring the supervision
of skilled nursing personnel) or other
skilled rehabilitation services that, as a
practical matter, can only be provided
in a SNF on an inpatient basis.
The Medicare program requires, as a
condition for Medicare Part A payment
for posthospital skilled nursing facility
(SNF) services, that a physician or other
authorized practitioner must certify and
periodically recertify that a beneficiary
requires an SNF level of care. The
physician certification and
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recertification is intended to ensure that
the beneficiary’s need for services has
been established and then reviewed and
updated at appropriate intervals. The
documentation is a condition for
Medicare Part A payment for posthospital SNF care. Form Number: CMS–
R–5 (OMB control number 0938–0454);
Frequency: Occasionally; Affected
Public: Private Sector (Business or other
for-profits); Number of Respondents:
2,315,259; Number of Responses:
2,315,259; Total Annual Hours: 522,199.
(For policy questions regarding this
collection contact Kia Burwell at 410–
786–7816).
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Notice of Denial
of Medicare Prescription Drug Coverage;
Use: Part D plan sponsors are required
to issue the Notice of Denial of Medicare
Prescription Drug Coverage notice when
a request for a prescription drug or
payment is denied, in whole or in part.
The written notice must include a
statement, in understandable language,
the reasons for the denial and a
description of the appeals process.
The purpose of this notice is to
provide information to enrollees when
prescription drug coverage has been
denied, in whole or in part, by their Part
D plans. The notice must be readable,
understandable, and state the specific
reasons for the denial. The notice must
also remind enrollees about their rights
and protections related to requests for
prescription drug coverage and include
an explanation of both the standard and
expedited redetermination processes
and the rest of the appeal process. Form
Number: CMS–10146 (OMB control
number 0938–0973); Frequency:
Occasionally; Affected Public: Private
Sector (Business or other for-profits);
Number of Respondents: 683; Number
of Responses: 2,627,898; Total Annual
Hours: 656,975. (For policy questions
regarding this collection contact Coretta
Edmondson at 410–786–0512).
Dated: December 9, 2022.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office
of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2022–27167 Filed 12–14–22; 8:45 am]
BILLING CODE 4120–01–P
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]]>Agencies
[Federal Register Volume 87, Number 240 (Thursday, December 15, 2022)]
[Notices]
[Pages 76621-76624]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-27175]
=======================================================================
-----------------------------------------------------------------------
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
[[Page 76622]]
information collection project ``The AHRQ Safety Program for
Telemedicine: Improving the Diagnostic Process and Improving Antibiotic
Use.''
DATES: Comments on this notice must be received by February 13, 2023.
ADDRESSES: Written comments should be submitted to: Doris Lefkowitz,
Reports Clearance Officer, AHRQ, by email at
[email protected].
Copies of the proposed collection plans, data collection
instruments, and specific details on the estimated burden can be
obtained from the AHRQ Reports Clearance Officer.
FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427-1477, or by email at
[email protected].
SUPPLEMENTARY INFORMATION:
Proposed Project
The AHRQ Safety Program for Telemedicine: Improving the Diagnostic
Process and Improving Antibiotic Use
Telemedicine visits increased dramatically in response to the
COVID-19 pandemic and resulting changes in third-party payer
reimbursement policies. Telemedicine visits increased from 0.3 percent
of all ambulatory visits in 2019 to 23.6 percent by Spring 2020. Given
this rapid growth, the need to ensure safe and appropriate patient care
in this setting is urgent. Telemedicine has many benefits, such as
facilitating continuity of care; improving access beyond normal hours;
reducing patients' travel burden; overcoming health care provider (HCP)
shortages; and providing support for patients managing chronic health
conditions. However, transferring clinical practices from an in-person
to a virtual environment poses potential risks. Many HCPs have never
received formal training in using telemedicine effectively to diagnose
and treat patients virtually. Additionally, inadequate internet access,
which disproportionately impacts rural and minority populations, and
struggles accessing telemedicine platforms may force video-based
telemedicine visits to transition to audio-only or be skipped.
This program aims to improve two at-risk areas among telemedicine
practices by implementing the AHRQ- and Johns Hopkins Armstrong
Institute for Patient Safety and Quality (JHAI)-developed Comprehensive
Unit-based Safety Program (CUSP) approach: (1) the diagnostic process
for breast, colorectal, and lung cancer; and (2) antibiotic stewardship
(AS). The CUSP approach improves safety culture at the practice level,
enables harm prevention, and engages providers who are on the front
lines while integrating technical and adaptive/cultural approaches to
making sustainable changes.
This program constitutes the first large-scale implementation of a
quality improvement effort for the cancer diagnostic process and AS in
telemedicine. These areas were chosen given the need for clearer
guidance and evidence-based telemedicine practices for clinicians and
potential for positive impact on outcomes. This program will
incorporate CUSP strategies to improve the diagnostic process for
breast, colorectal, and lung cancer and to improve antibiotic
prescribing in telemedicine. The program goals are to:
Identify best practices in implementing interventions to
improve the cancer diagnostic process and AS in telemedicine.
Determine how best to adapt CUSP to enhance the cancer
diagnostic process and AS in telemedicine.
This study is being conducted by AHRQ through its contractor, NORC
at the University of Chicago (NORC) and NORC's subcontractors, the
Johns Hopkins Armstrong Institute of Patient Safety and Quality (JHAI)
and Baylor College of Medicine (Baylor), 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 value of
healthcare services and with respect to quality measurement and
improvement. 42 U.S.C. 299a(a)(1) and (2)
Method of Collection
To achieve the goals of the AHRQ Safety Program for Telemedicine
(``Safety Program''), primary and secondary data collection activities
will include:
(1) Structural Assessment: A brief online assessment will be
completed by a leader/champion from each practice to understand
practices' infrastructure and capacity to implement the Safety Program.
(2) AHRQ Office Readiness Survey: A brief online Office Readiness
Survey will be completed by all participating staff from each practice
in the cancer diagnostic process cohort to understand practices'
readiness for implementation of the Safety Program.
(3) The AHRQ Surveys on Patient Safety Culture: The Medical Office
Survey on Patient Safety Culture (MOSOPS) (both cohorts) and a
Diagnostic Safety Supplement (cancer diagnostic process cohort only)
will be completed by all participating staff to assess patient safety
issues, medical errors, and event reporting practices.
(4) Participant Experience Survey: A brief online assessment will
be completed by a leader/champion from each practice to assess how
practices approached implementation of the Safety Program.
(5) Semi-Structured Qualitative Interviews: A proportion of
practices from both cohorts will be selected to participate in
telephone/virtual discussions to understand the facilitators and
barriers to implementing the Safety Program.
(6) Clinical Data Collection Form: Practices in the cancer
diagnostic process cohort will complete a Clinical Data Collection Form
for patients suspected of having breast, colorectal, or lung cancer.
(7) Electronic Health Record (EHR) Data: Practice-level antibiotic
usage and clinical outcomes data will be extracted from the EHRs of
practices in the AS cohort.
This data collection effort will be part of a comprehensive
evaluation strategy to assess the adoption of the Safety Program among
telemedicine practices comprising the cancer diagnostic process and AS
cohorts; measure the effectiveness of the Safety Program among the
participating practices and evaluate how providers experienced the
program as well as the perceived usefulness of the Safety Program's
education materials and metrics; and understand drivers of antibiotic
prescribing among practices in the AS cohort and drivers of timely
diagnosis for patients suspected of having breast, colorectal, or lung
cancer among practices in the cancer diagnostic process cohort.
The evaluation is largely formative in nature as AHRQ seeks
information on the implementation and effectiveness of CUSP in a novel
setting--telemedicine. The evaluation will utilize a pre-post design,
comparing data collected at baseline and at the end of the Safety
Program within each cohort.
Estimated Annual Respondent Burden
Exhibit A.1 shows the estimated annualized burden hours for the
respondents' time to complete the structural assessments, AHRQ office
readiness and patient safety culture surveys, participant experience
surveys, semi-structured qualitative interviews, clinical data
collection instrument (collected for 3 patients monthly and submitted
quarterly), and EHR data extractions (collected monthly and submitted
quarterly). Data will be collected from up to 300 practices providing
telemedicine for the cancer diagnostic process cohort and from up to
500 practices providing telemedicine
[[Page 76623]]
for the AS cohort. For the three-year clearance period, the estimated
annualized burden hours for the data collection activities are 5,570.
Exhibit A.1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
Number of
Form name Number of responses per Hours per Total burden
respondents * respondent response hours
----------------------------------------------------------------------------------------------------------------
1. Structural Assessments (both cohorts)........ 200 2 0.2 80
2. AHRQ Office Readiness Survey (cancer 350 1 0.1 35
diagnostic process cohort only)................
3. AHRQ Patient Safety Culture Surveys:
a. MOSOPS (both cohorts).................... 933 2 0.5 933
b. Diagnostic Safety Supplement (cancer 350 2 0.2 140
diagnostic process cohort only)............
4. Participant Experience Survey (both cohorts):
a. Cancer diagnostic process cohort survey.. 75 1 0.17 13
b. AS cohort survey......................... 125 1 0.33 41
5. Semi-structured qualitative interviews (both 24 1 1 24
cohorts).......................................
6. Clinical Data Collection Form (cancer 90 54 0.33 1,604
diagnostic process cohort).....................
7. HER data (AS cohort)......................... 150 18 1 2,700
---------------------------------------------------------------
Total....................................... .............. .............. .............. 5,570
----------------------------------------------------------------------------------------------------------------
* Annualized number of respondents is based on maximum practices recruited and 75% response rate for forms 1 and
4a and 4b, 50% response rate for forms 2, 3a and 3b, and 90% response rate for forms 5-7.
Exhibit A.2 shows the estimated annualized cost burden based on the
respondents' time to complete the data collection forms. The total cost
burden is estimated to be $576,922.
Exhibit A.2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
Average
Form name Number of Total burden hourly wage Total burden
respondents * hours rate ** cost
----------------------------------------------------------------------------------------------------------------
1. Structural Assessments (both cohorts)........ 200 80 \a\ $111.30 $8,904
2. AHRQ Office Readiness Survey (cancer 350 35 \a\ 111.30 3,896
diagnostic process cohort only)................
3. AHRQ Patient Safety Culture Surveys:
a. MOSOPS (both cohorts):
i. Physicians........................... 466 466 \a\ 111.30 51,866
ii. Other Health Practitioners.......... 467 467 \b\ 31.19 14,566
b. Diagnostic Safety Supplement (cancer
diagnostic process cohort only):
i. Physicians........................... 175 70 \a\ 111.30 7,791
ii. Other Health Practitioners.......... 175 70 \b\ 31.19 2,183
4. Participant Experience Survey (both cohorts). 200 54 \a\ 111.30 6,010
5. Semi-structured qualitative interviews (both 24 24 \a\ 111.30 2,671
cohorts).......................................
6. Clinical Data Collection Form (cancer 90 1,604 \a\ 111.30 178,525
diagnostic process cohort only)................
7. EHR data (AS cohort only).................... 150 2,700 \a\ 111.30 300,510
---------------------------------------------------------------
Total....................................... 3,497 5,582 .............. 576,922
----------------------------------------------------------------------------------------------------------------
* Annualized number of respondents is based on maximum practices recruited and 75% response rate for forms 1 and
4, 50% response rate for forms 2, 3a and 3b, and 90% response rate for forms 5-7.
** National Compensation Survey: Occupational wages in the United States May 2021 ``U.S. Department of Labor,
Bureau of Labor Statistics:'' https://www.bls.gov/oes/current/oes_stru.htm#29-0000.
\a\ Based on the mean wages for 29-1069 Physicians and Surgeons, All Other.
\b\ Based on the mean wages for 29-9099 Miscellaneous Health Practitioners and Technical Workers: Healthcare
Practitioners and Technical Workers, All Other.
Request for Comments
In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-
3520, 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's health
care research and health care information dissemination functions,
including whether the information will have practical utility; (b) the
accuracy of AHRQ's estimate of burden (including hours and costs) of
the proposed collection(s) of information; (c) ways to enhance the
quality, utility and clarity of the information to be collected; and
(d) ways to minimize the burden of the collection of information upon
the respondents, including the use of automated collection techniques
or other forms of information technology.
Comments submitted in response to this notice will be summarized
and included in the Agency's subsequent request for OMB approval of the
proposed information collection. All comments will become a matter of
public record.
[[Page 76624]]
Dated: December 9, 2022.
Marquita Cullom,
Associate Director.
[FR Doc. 2022-27175 Filed 12-14-22; 8:45 am]
BILLING CODE 4160-90-P
