Agency Information Collection Activities: Proposed Collection; Comment Request
| Published date | 24 June 2020 |
| Citation | 85 FR 37947 |
| Record Number | 2020-13574 |
| Section | Notices |
| Court | Agency For Healthcare Research And Quality,Health And Human Services Department |
Federal Register, Volume 85 Issue 122 (Wednesday, June 24, 2020)
[Federal Register Volume 85, Number 122 (Wednesday, June 24, 2020)]
[Notices]
[Pages 37947-37949]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-13574]
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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.
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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: ``Patient-Centered Outcomes Research Clinical Decision
Support: Current State and Future Directions.'' This proposed
information collection was previously published in the Federal Register
on March 25, 2020. AHRQ received no 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
``Patient-Centered Outcomes Research Clinical Decision Support: Current
State and Future Directions''
Research has shown that health care quality in the U.S. varies
significantly and only half of adults receive evidence-based,
recommended care. Individuals with multiple chronic conditions (42% of
adults) and older adults are at particular risk for negative health
outcomes. Current evidence shows that clinical decision support (CDS)
systems improve adherence to evidence-based practices by analyzing
patient data and making appropriate information available to the
physician at the time they need it. CDS systems are usually electronic
health record (EHR)-based, encompassing tools like alerts, clinical
guidelines, patient reports and dashboards, diagnostic support, and
workflow tools. These tools help reduce clinical errors and allow for
customization to patient needs, improving quality of care and patient
outcomes.
The AHRQ Patient-Centered (PC) CDS Learning Network (PC CDS LN)
defines PC CDS as: ``CDS that supports individual patients and their
approved care givers and/or care teams in health-related decisions and
actions by leveraging information from PCOR findings and/or patient-
specific information (e.g., patient-generated health data).'' Through
PC CDS, AHRQ seeks to accelerate the movement of patient-centered
outcomes research (PCOR) evidence into practice and to make CDS more
shareable, standards-based, and publicly available.
Traditionally, CDS initiatives have focused on provider-directed
guidelines and increasing the shareability of CDS artifacts; however,
PC CDS targets both patients (and/or caregivers) and providers.
AHRQ's effort to support PC CDS has included efforts such as the PC
CDS LN, CDS Connect, and other related grants and contracts. In this
project, AHRQ seeks to conduct a comprehensive evaluation to assess the
impact of AHRQ's PCOR CDS Initiative (the Initiative) on understanding
of the current state of PC CDS and to identify gaps to guide AHRQ's
future research.
This research has the following goal:
To assess the accomplishments and opportunities for the Initiative
as a whole, and each of its four individual components: The PC CDS
Learning Network, CDS Connect, Quantifying Efficiencies, and the U18
CDS Resource Grants.
This study is being conducted by AHRQ through its contractor, NORC
at the University of Chicago, pursuant to AHRQ's statutory authority to
disseminate government-funded research relevant to comparative clinical
effectiveness research. 42 U.S.C. 299b-37(a)-(c).
Method of Collection
To achieve these goals, the evaluation team will use key informant
interviews and a web-based survey to gather information about the
programs from stakeholders, contributors, and users of the CDS
Initiative programs.
Key Informant Interviews: The evaluation team will conduct semi-
structured interviews with people involved in the Initiative's
components, including representatives from academia, industry, health
systems, and government. Key informants will include the following
groups:
Leaders: Includes AHRQ project officers, contractor's senior staff,
and senior consultants to Initiative components. Leaders are expected
to have set the direction of the components or activities and to be
familiar with the activities, the processes of implementation, and
their outputs in their entirety.
Contributors: Includes lead authors or content developers for a
product or output of a component, and may overlap with leaders.
Examples of contributors from the PC CDS LN include lead authors of the
Trust Framework, Opioid Action Plan, or Patient Blogs; examples from
the CDS Connect include individuals who contributed CDS artifacts to
the repository.
Participants: Includes individuals who participated in workgroups
of either the PC CDS LN or CDS Connect, or participated in the
development of one of the products.
Consumers: Includes individuals who have used a product developed
by the Initiative, including artifacts found on
[[Page 37948]]
the CDS Connect repository and the CDS Connect Authoring Tool in
particular. Individuals will be identified from interviews with
leaders, contributors, and participants, and through literature review
for authors making references to Initiative products (i.e., reports or
artifacts).
AHRQ and the evaluation contractor will create a list of eligible
key informants that reflect the appropriate mix of roles and depth of
experience to ensure comprehensive evaluation. Key informants will
receive invitational emails that explain the scope and allow candidates
to ask questions before declining or accepting the invitation. We will
include clinical staff in our sample of participants in the Quantifying
Efficiencies grant program, the U18 grants and the two opioid-related
CDS projects. Involving staff at clinical sites will also be critical
to understanding the value of PC CDS in the context of provider
workflows and burdens.
Web Survey: The purpose of the web survey is to understand more
about who the users of CDS Connect resources are, their reasons for
using the resources, how they use these resources, and their
perceptions about their value. The CDS Connect resources of interest
include the CDS Authoring Tool, artifacts in the CDS Connect Repository
and open-source CDS Connect resources available on Github, a platform
for developing and sharing software. Respondents will be identified
through a chain-referral methodology. The first set of survey
invitations will be sent to a list of email addresses of known
contributors or users of CDS Connect as well as a group of potential
users of CDS Connect. At the end of the survey, each respondent will be
asked to provide names and email addresses for up to four other users
of CDS Connect resources. After the list of names from all referrals is
deduplicated, a survey invitation will be sent to these referrals.
The survey instrument includes multiple choice questions that
capture important data points about use of CDS Connect resources,
specifically the CDS Authoring tool, GitHub resources, and artifacts
from the CDS Repository. Respondents will only be presented with more
detailed questions about CDS Connect resource usage based on their
responses to initial screening questions. The survey will take ten
minutes on average to complete based on in-house testing.
This mixed methods evaluation seeks to answer the following
research questions about the Initiative as a whole:
1. To what extent has the Initiative promoted the dissemination and
implementation of PCOR findings through sharable, standards-based, and
publicly available CDS and how?
2. What activities carried out through each component (e.g.,
webinars, workgroups, in-person meetings, repositories, CDS artifacts
and development tools, final reports or plans) were found to be most
successful in furthering the various goals of the Initiative?
3. What do stakeholders perceive to be the impacts of the
Initiative to date, including reflection on their own involvement in
it, and current or potential achievements, such as the development of a
common definition of PC CDS and growth of interest in and capacity for
developing these types of CDS among stakeholders?
4. How does the Initiative address federal policies for the
dissemination and implementation of evidence-based research funded by
the PCOR Trust Fund, and how do they interact with other federal policy
initiatives designed to promote widespread use, interoperability and
patient access to information from EHRs with advanced CDS.
5. What can AHRQ learn from the Initiative that is relevant to
other initiatives aimed at disseminating and implementing clinical
evidence and evidence-based practices? How can the lessons learned here
inform future research, implementation, and dissemination initiatives?
Information collected by the study will inform strategies to
promote the adoption of PCOR evidence into practice through CDS
developed by AHRQ and other Department of Health and Human Services
agencies, including the Centers for Medicare & Medicaid Services (CMS)
and the Office of the National Coordinator for Health IT, as well as
state and local governments and private health care organizations.
Findings from the evaluation can help identify and shape strategies to
promote more effective implementation of PCOR CDS in order to
accelerate the movement of evidence into clinical practice and support
patient-centered decision making by clinicians with their patients.
Estimated Annual Respondent Burden
Key Informant Interviews. Key informant interviews will be
conducted with up to 147 key informants across a variety of
organizations involved in each component of the Initiative. NORC will
use one of 14 interview protocols based on the component the key
informant is involved in and their role in that component. As shown in
Exhibit 1, the interview form names include the type of role of the key
informant in the project. All interviews are expected to last one hour.
Some key informants may serve multiple roles or work on multiple
projects. In these cases, the relevant protocols will be combined and
streamlined so that the informant only completes one interview. Some of
the key informant interviews for the sites or Opioid-related grants may
be conducted during the course of site visits at the implementation
sites, either with individuals or small groups of respondents.
Web Survey. For the web survey, it is estimated that 453 CDS
Connect users will respond to the 10-minute survey. The total annual
burden hours for the key informant interviews and surveys is estimated
to be 224 hours as shown in Exhibit 1.
Exhibit 1--Estimated Annualized Burden Hours
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Number of Hours per Total burden
Form name respondents response hours
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PC CDS Learning Network--Leader................................. 7 1 7
PC CDS Learning Network--Governance/Non-Executive Steering 3 1 3
Committee......................................................
PC CDS Learning Network--Contributor............................ 8 1 8
CDS Connect--Leader............................................. 5 1 5
CDS Connect--Contributor........................................ 20 1 20
CDS Connect--Consumer/Patient................................... 25 1 25
CDS Connect--Participant........................................ 10 1 10
Quantifying Efficiencies--Leader................................ 5 1 5
Quantifying Efficiencies--Informaticist......................... 4 1 4
Quantifying Efficiencies--Clinician............................. 8 1 8
[[Page 37949]]
PC CDS Projects--Site Leader.................................... 18 1 18
PC CDS Projects--Informaticist.................................. 10 1 10
PC CDS Projects--Clinician...................................... 20 1 20
PC CDS Projects--Patient........................................ 4 1 4
Web Survey of CDS Connect Users................................. 453 .17 77
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Total....................................................... 600 .............. 224
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Exhibit 2 shows the estimated annual cost burden associated with
the respondents' time to participate in this information collection,
which comes to $14,371.85.
Exhibit 2--Estimated Annualized Cost Burden
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Average
Form name Number of Total burden hourly wage Total cost
interviews* hours rate** burden
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PC CDS Learning Network--Leader................. 7 7 \1\ $59.54 $416.78
PC CDS Learning Network--Governance/Non- 3 3 \1\ 59.54 178.62
Executive Steering Committee...................
PC CDS Learning Network--Contributor............ 8 8 \1\ 59.54 476.33
CDS Connect--Leader............................. 5 5 \1\ 59.54 297.71
CDS Connect--Contributor........................ 20 20 \1\ 59.54 1,190.82
CDS Connect--Consumer........................... 25 25 \1\ 59.54 1,488.53
CDS Connect--Participant........................ 10 10 \1\ 59.54 595.41
Quantifying Efficiencies--Leader................ 5 5 \1\ 59.54 297.71
Quantifying Efficiencies--Informaticist......... 4 4 \1\ 59.54 238.16
Quantifying Efficiencies--Clinician............. 8 8 \2\ 101.43 811.46
PC CDS Projects--Site Leader.................... 18 18 \1\ 59.54 1,071.74
PC CDS Projects--Informaticist.................. 10 10 \1\ 59.54 595.40
PC CDS Projects--Clinician...................... 20 20 \2\ 101.43 2,028.60
PC CDS Projects--Patient........................ 4 4 \3\ 24.98 99.93
Web Survey of CDS Connect Users................. 453 77 \1\ 59.54 4,584.66
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Total....................................... 600 224 .............. 14,371.85
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** Wage rates were calculated using the mean hourly wage from the U.S. Department of Labor, Bureau of Labor
Statistics, May 2018 National Occupational Employment and Wage Estimates for the United States, https://www.bls.gov/oes/current/oes_nat.htm.
\1\ Average rate for Computer Information and Research Scientists
\2\ Average rate for Physicians and Surgeons
\3\ Average rate for All Occupations
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'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.
Dated: June 18, 2020.
Virginia L. Mackay-Smith,
Associate Director.
[FR Doc. 2020-13574 Filed 6-23-20; 8:45 am]
BILLING CODE 4160-90-P
