Agency Information Collection Activities; Proposals, Submissions, and Approvals
Federal Register: March 16, 2009 (Volume 74, Number 49)
Notices
Page 11109-11111
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
DOCID:fr16mr09-59
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: ``Improving Patient Flow and Reducing Emergency Department
Crowding.'' In accordance with the Paperwork Reduction Act of 1995, 44
U.S.C. 3506(c)(2)(A), AHRQ invites the public to comment on this proposed information collection.
This proposed information collection was previously published in the Federal Register on January 15th, 2009 and allowed 60 days for public comment. One comment was received. The purpose of this notice is to allow an additional 30 days for public comment.
DATES: Comments on this notice must be received by April 15, 2009.
ADDRESSES: Written comments should be submitted to: AHRQ's OMB Desk
Officer by fax at (202) 395-6974 (attention: AHRQ's desk officer) or by e-mail at OIRA_submission@omb.eop.gov (attention: AHRQ's desk officer).
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 e-mail at doris.lefkowitz@ahrq.hhs.gov.
SUPPLEMENTARY INFORMATION:
Proposed Project
``Improving Patient Flow and Reducing Emergency Department
Crowding'' AHRQ proposes to study implementation of strategies from the
Urgent Matters (UM) Toolkit for improving patient flow in emergency departments (ED). UM, a Robert Wood Johnson Foundation (RWJF) funded initiative, began as a collaborative of 10 urban, safety net hospitals that experimented with a variety of strategies (now included in the
``UM Toolkit'') designed to relieve ED crowding. The first phase of this initiative demonstrated that reductions in ED crowding were achievable without investment of significant financial resources.
However, implementation of these strategies has not been widespread, and questions remain about how readily the strategies could be implemented in a more diverse group of hospitals, and the associated costs and outcomes of implementation. This study is funded by a grant from RWJF to AHRQ.
Six diverse hospitals have been selected for this study of the implementation of strategies from the UM Toolkit for improving ED patient flow. This study poses a common outcome goal across all six sites of improving patient flow and reducing ED crowding, but requires each hospital to select strategies that fit its own needs and context.
This approach rests on innovation research showing that organizational innovations are more successful when they are aligned with features of the adopting hospital. Participating hospitals will select strategies from the UM Toolkit that they believe will work best to address the particular problems they face. The six hospitals have agreed to participate in a collaborative run by the UM National Program Office
(NPO) over the course of this study to facilitate the sharing of data and experiences while the project is underway.
This study will document the experiences of a diverse set of hospital EDs as they identify and implement ED patient flow improvement strategies. The six case study hospitals were selected to reflect diversity of size, ownership, teaching status, safety net status, and types of challenges with ED crowding.
Research methods will include observational site visits, in-person and telephone interviews, and the analysis of cost data. AHRQ's contractor for this study, Health Research & Educational Trust (HRET), will perform analysis of secondary data on ED performance measures; this secondary data will be provided to HRET by the Urgent Matters NPO.
These qualitative and quantitative methods will be used to:
Study the processes through which hospitals decide upon and adopt patient flow improvement strategies;
Page 11110
Identify facilitators and barriers to the implementation and maintenance of these strategies;
Document changes in patient flow, patient satisfaction, and staff satisfaction associated with the implementation of strategies and processes;
Generate estimates of the costs of adopting the strategies;
Identify issues associated with the reporting of ED performance measures; and,
Develop lessons for hospitals considering the adoption of patient flow improvement strategies.
The study will not be used to answer questions about causality or degrees of effectiveness (e.g., to what degree did a given intervention cause an improvement in patient flow?). Rather, the study seeks to enhance understanding of factors affecting decision-making and adoption processes that facilitate or hinder implementation. Insights and lessons learned about organizational, technical and resource challenges arising from these improvement activities may be of interest or benefit to others seeking to identify and adopt strategies to address similar problems in their EDs.
This study is being conducted 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 health care services; quality measurement and improvement; and health care costs, productivity, organization, and market forces. 42 U.S.C. 299a(a)(1), (2), and (6).
Method of Collection
AHRQ seeks approval for the following data collection activities:
In-person interviews will be conducted within two months of the implementation with up to 12 individuals at each of the 6 sites during two-day site visits to each of the hospitals.
Telephone interviews will be conducted approximately 6 months after implementation with 12 individuals from each of the six hospitals (most or all of whom will be the same individuals interviewed in person).
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the hospitals' time to participate in this study. In-person interviews will be conducted within two months of implementation with 12 administrative and clinical personnel from each of the six participating hospitals and will require about one hour. Telephone interviews will be conducted approximately six months thereafter with 12 individuals (administrative and clinical) from each hospital and will take about 45 minutes. The total estimated burden for participation in this study is 126 hours.
Exhibit 1--Estimated Annualized Burden Hours
Number of
Data collection
Number of
responses per
Hours per
Total burden hospitals
hospital
response
hours
In-person interviews............................
6
12
1.0
72
Telephone interviews............................
6
12
45/60
54
Total.......................................
12
na
na
126
Exhibit 2 shows the estimated annualized cost burden for the respondents' time to provide the requested data. The total cost burden is approximately $4,419.
Exhibit 2--Estimated Annualized Cost Burden
Total burden Average hourly
Total cost
Data collection
hours
wage rate *
burden
In-person interviews............................................
72
$35.07
$2,525
Telephone interviews............................................
54
$35.07
1,894
Total.......................................................
126
na
4,419
* For the interviews, the hourly rate of $35.07 is an average of the admini strative personnel hourly wage of
$14.53, the physician rate of $62.52, and the registered nurse rate of $28.15. National Compensation Survey:
Occupational Wages in the United States 2005, U.S. Department of Labor, Bureau of Labor Statistics.
Estimated Annual Costs to the Federal Government
Exhibit 3 shows the total and annualized cost to the government for this eighteen-month study.
Exhibit 3--Estimated Cost
Annualized
Cost component
Total cost
cost
Project Development.....................
52,446
34,964
Data Collection Activities..............
90,298
60,199
Page 11111
Data Processing and Analysis............
70,569
47,046
Publication of Results..................
41,420
27,613
Project Management......................
68,908
45,939
Overhead................................
76,320
50,880
Total...............................
$399,961
266,641
Request for Comments
In accordance with the above-cited Paperwork Reduction Act legislation, 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: March 9, 2009.
Carolyn M. Clancy,
Director.
FR Doc. E9-5581 Filed 3-13-09; 8:45 am
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