74 FR 10 pgs. 2596-2598 - Agency Information Collection Activities: Proposed Collection; Comment Request
Type: NOTICEVolume: 74Number: 10Pages: 2596 - 2598
FR document: [FR Doc. E9-537 Filed 1-14-09; 8:45 am]
Agency: Health and Human Services Department
Sub Agency: Agency for Healthcare Research and Quality
Official PDF Version: PDF Version
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.
DATES:
Comments on this notice must be received by March 16, 2009.
ADDRESSES:
Written comments should be submitted to: Doris Lefkowitz, Reports Clearance Officer, AHRQ, by e-mail 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 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 amid 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 under way.
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;
• 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 ofeffectiveness (e.g to what degree did a given intervention cause animprovement in patient flow?). Rather, the study seeks to enhanceunderstanding of factors affecting decision-making and adoption processes thatfacilitate or hinder implementation. Insights and lessons learned aboutorganizational, technical and resource challenges arising from theseimprovement activities may be of interest or benefit to others seeking toidentify and adopt strategies to address similar problems in their EDs.
This study is being conducted pursuant to AHRQ's statutory authority toconduct and support research on health care and on systems for the delivery ofsuch care, including activities with respect to: The quality, effectiveness, efficiency, appropriateness and value of health care services; qualitymeasurement 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 theimplementation with up to 12 individuals at each of the 6 sites during two-daysite visits to each of the hospitals.
• Telephone interviews will be conducted approximately 6 months afterimplementation with 12 individuals from each of the six hospitals (most or allof whom will be the same individuals interviewed in person).
• Each of the six hospitals will submit information on the costs associatedwith the planning, implementation, and maintenance of the patient flowimprovement strategies on a monthly basis. One study team member at each sitewill record costs on an assessment instrument specifically designed for thispurpose and tailored to each hospital's own organizational structure andpatient flow strategies.
This assessment instrument will collect information on staff time devoted tothe patient flow improvement initiatives as well as the costs of items orresources purchased to support the initiatives.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the hospitalst timeto participate in this study. In-person interviews will be conducted withintwo months of implementation with 12 administrative and clinical personnelfrom each of the six participating hospitals and will require about one hour.Telephone interviews will be conducted approximately six months thereafterwith 12 individuals (administrative and clinical) from each hospital and willtake about 45 minutes. Monthly cost assessment data will be collected fromeach participating hospital each month and will require about one hour. Thetotal estimated burden for participation in this study is 198 hours.
Exhibit 2 shows the estimated annualized cost burden for the respondents' timeto provide the requested data. The total cost burden is approximately $6,536.
| Data collection | Number of respondents | Number of responses per respondent | Hours per response | Total burden hours |
|---|---|---|---|---|
| In-person interviews | 6 | 12 | 1 | 72 |
| Telephone interviews | 6 | 12 | 45/60 | 54 |
| Cost Assessment | 6 | 12 | 1 | 72 |
| Total | 18 | na | na | 198 |
| Data collection | Number of respondents | Total burden hours | Average hourly wage rate* | Total cost burden |
|---|---|---|---|---|
| In-person interviews | 6 | 72 | $35.07 | $2,525 |
| Telephone interviews | 6 | 54 | 35.07 | 1,984 |
| Cost Assessment | 6 | 72 | 28.15 | 2,027 |
| Total | 18 | 198 | na | 6,536 |
| * For the interviews, the hourly rate of $35.07 is an average of the administrative personnel hourly wage of $14.53, the physician rate of $62.52, and the registered nurse rate of $28.15. For cost assessment, the hourly rate of $28.15 is the hourly rate for registered nurses. 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 thiseighteen-month study.
| Cost component | Total cost | Annualized cost |
|---|---|---|
| Project Development | $52,446 | $34,964 |
| Data Collection Activities | 90,298 | 60,199 |
| 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 ofthe following: (a) Whether the proposed collection of information is necessaryfor the proper performance of AHRQ's health care research and health careinformation dissemination functions, including whether the information willhave 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 becollected; and (d) ways to minimize the burden of the collection ofinformation upon the respondents, including the use of automated collectiontechniques or other forms of information technology.
Comments submitted in response to this notice will be summarized and includedin the Agency's subsequent request for OMB approval of the proposedinformation collection. All comments will become a matter of public record.
Dated: December 30, 2008.
Carolyn M. Clancy,
Director.
[FR Doc. E9-537 Filed 1-14-09; 8:45 am]
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