[Federal Register: September 3, 2008 (Volume 73, Number 171)]
[Notices]
[Page 51484-51487]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr03se08-77]
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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: ``Study of Factors Influencing Consumer Choices Among Health
Plans and Clinicians.'' In accordance with the Paperwork Reduction Act
of 1995, Public Law 104-13 (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 November 3, 2008.
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 e-mail at
doris.lefkowitz@ahrq.hhs.gov.
SUPPLEMENTARY INFORMATION:
Proposed Project
``Study of Factors Influencing Consumer Choices Among Health Plans
and Clinicians''
This study will use an experimental design to determine factors
that influence consumer understanding and use of performance
information to select among health plans and clinicians. Performance
reports on health plans and individual providers have become
increasingly available in recent years, but there is little evidence
regarding how consumers understand and use different types of
performance information to make choices.
The study will include two parallel experiments, one designed to
assess factors influencing choice of health plans and one designed to
assess factors influencing choice of individual doctors. Both
experiments will present a panel of online consumers with a simulated
Web-based performance report. Study subjects will answer a series of
pre-test questions, and then be directed to a Web site with a simulated
report (for either health plans or doctors) where they will view
various types of performance information, go through the process of
selecting either a health plan or a doctor, and then complete the
experiment by answering a series of post-test questions about how they
made their selection.
The categories of performance information to be included in the Web
reports will be derived from patient experience survey results using
Consumer Assessment of Healthcare Providers and Systems (CAHPS)
composite measures, clinical process measures, personal anecdotes based
on patient or enrollee experiences, and the frequency of different
types of enrollee complaints or grievances (in the plan experiment
only).
The results of this study will be used to develop recommendations
for helping consumers to better understand and more effectively use
complex information to select health plans and providers, with the aim
of making performance information less burdensome and more accessible,
useful, and transparent to the public. The simulated Web-based reports
will be made available as examples for other report developers to use.
This study is being conducted pursuant to AHRQ's statutory mandate to
promote health care quality improvement by conducting and supporting
research that develops and presents scientific evidence regarding all
aspects of health care, 42 U.S.C. 299(b)(1), and to conduct research on
health care and on systems for the delivery of such health care, 42
U.S.C. 299a.
Method of Collection
Participants in this study will be recruited through the Knowledge
Networks national online panel of consumers. For both the health plan
and clinician choice experiments, study subjects will be randomly
assigned to one of several arms (described below)
[[Page 51485]]
that vary according to the type and complexity of performance
information and the size of the choice set (number of plans or doctors)
included in the Web report. Participants will complete the experiment
through a secure online connection from their homes.
Clinician Choice Experimental Design
In each of the six arms, study participants will see a web page
labeled ``Performance Overview'' that presents performance information
for a set of primary care doctors in a way that allows them to compare
doctor ratings. Performance is summarized by assigning one to five
stars to show how each doctor compares with others in the same zip code
area. Participants can click on hyperlinks or a tab to see more
detailed results. The experimental arms differ in the type and amount
of performance information presented and the number of doctors listed,
as described below:
(1) Baseline/Control Arm: participants see only ``Patient Survey
Results'' for each of 12 doctors in this arm. This includes a summary
measure on the Performance Overview page and more detailed measures
corresponding to CAHPS composites and an overall doctor rating on the
drill-down page.
(2) Experimental Arm #1: Augmented Quantified Performance Measures:
In this arm participants will also see ``Patient Survey Results'' on 12
doctors. In addition, they will see a summary clinical performance
measure labeled ``Medical Quality Scores.'' The drill-down page shows
that this is based on clinical indicators for prevention and screening,
care for asthma, care for diabetes, and care for heart disease.
(3) Experimental Arm #2: CAHPS plus Anecdotes: In this arm,
participants will again be presented with ``Patient Survey Results'' on
12 doctors. In addition, for each doctor, they will see a tab labeled
``Patient Comments.'' By clicking on this tab, they can see from four
to six patient comments describing patients' experiences with each
doctor. Participants in this arm will not see clinical performance
scores.
(4) Experimental Arm #3: Augmented Quantified Performance Measures
Plus Anecdotes: In this arm participants will be presented with all
three types of information on 12 doctors: ``Patient Survey Results,''
``Medical Quality Scores'', and ``Patient Comments.''
(5) Experimental Arm #4: CAHPS plus Anecdotes and Larger Choice
Set: In this arm participants will be presented with ``Patient Survey
Results'' and ``Patient Comments'' on 24 doctors.
(6) Experimental Arm #5: Maximum Cognitive Load: Large Choice Set
and Three Measures of Performance: In this arm, participants are
presented with all three types of information on 24 doctors: ``Patient
Survey Results,'' ``Medical Quality Scores,'' and ``Patient Comments.''
The goals of the experiment are to assess the process of consumer
choice and the extent to which CAHPS-type measures are consulted, and
to examine how consumers respond to different types of information
about doctor quality, including quantitative patient experience
measures, anecdotal reports from individual patients, and clinical
performance indicators. The post-test questionnaire will elicit
participants' understanding and impressions of the material they saw on
the Web site and inquire about how they made their choice. Therefore,
the post-test questions will differ somewhat across experimental arms.
Health Plan Choice Experimental Design
The design of the health plan choice experiment has a comparable
architecture to the clinician-choice experiment, but makes choices more
challenging by adding more dimensions of performance measures within a
smaller choice set. (These distinctions between informed clinician
choice and informed plan choice replicate the information currently
available to consumers over the internet.) In each of the six arms,
study participants will see a web page labeled ``Performance Overview''
that presents performance information for a set of health plans in a
way that allows them to compare plan ratings. Performance is summarized
by assigning one to five stars to show how each plan compares with
others in the same community. Participants can click on hyperlinks or a
tab to see more detailed results. The experimental arms differ in the
type and amount of performance information presented and the number of
plans listed, as described below:
(1) Baseline/Control Arm: participants see only ``Patient Survey
Results'' for each of 4 plans in this arm. This includes a summary
measure on the Performance Overview page and more detailed measures
corresponding to CAHPS composites and an overall plan ratings on the
drill-down page.
(2) Experimental Arm #1: Augmented Quantified Performance Measures:
In this arm participants will also see ``Patient Survey Results'' on
four plans. In addition, they will see two summary clinical performance
measures labeled ``Health Care Quality Scores,'' which will consist of
selected Health Care Effectiveness Data and Information Set (HEDIS)
measures, one for preventive care, and one for the treatment of chronic
conditions. The drill-down page for prevention will show preventive
care scores of regular physical exams, and screening for three common
medical conditions. The drill down page for treatment will include
summary measures for heart problems, asthma, diabetes, and arthritis. A
summary score for the reported rate of consumer complaints will also be
included, with a drill down reporting rating for the four most common
causes of complaints, with the categories based on actual data from
three states.
(3) Experimental Arm #2: CAHPS plus Anecdotes: In this arm,
participants will again be presented with ``Patient Survey Results'' on
four plans. In addition, for each plan, they will see a tab labeled
``Patient Comments.'' By clicking on this tab, they can see from four
to six patient comments describing patients' experiences with each
plan. Participants in this arm will not see quality performance or
rates of patient complaints scores.
(4) Experimental Arm #3: Augmented Quantified Performance Measures
Plus Anecdotes: In this arm participants will be presented with all
four types of information for four plans: ``Patient Survey Results,''
``Health Care Quality Scores'', ``Patient Complaint Rates'' and
``Patient Comments.''
(5) Experimental Arm #4: CAHPS plus Anecdotes and Larger Choice
Set: In this arm participants will be presented with ``Patient Survey
Results'' and ``Patient Comments'' on 12 plans.
(6) Experimental Arm #5: Maximum Cognitive Load: Large Choice Set
and Five Measures of Performance: In this arm, participants are
presented with all three types of information: ``Patient Survey
Results,'' ``Health Care Quality Scores'' (both prevention and
treatment), ``Patient Complaint Rates'' and ``Patient Comments'' on 12
plans.
The goal of these experiments is to assess the process of consumer
choice and the extent to which CAHPS-type measures are consulted, and
to examine how consumers respond to different types of information
about plan performance, including quantitative patient experience
measures, anecdotal reports from individual patients, frequency of
consumer complaints, and clinical performance indicators. The post-test
questionnaire will elicit participants' understanding and impressions
of the material they saw on the Web site and inquire about how they
made their choice. Therefore, the post-test questions will differ
somewhat across experimental arms.
[[Page 51486]]
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
respondents' time to participate in this experiment. This experiment
will not exceed one year. All participants will complete the pre-test
which is estimated to require 5 minutes. As explained above, the
experimental Web site varies by experimental arm, however, each
participant is expected to require about 10 minutes to review the
information on the site. The baseline/control post-test will be
completed by 170 participants and will require about 7 minutes to
complete. Both the experimental arm 1 and 2 post-test
will be completed by 166 participants each and will take about 8
minutes. Both the experimental arm 3 and 4 post-test
will be completed by 166 participants each and will require about 12
minutes to complete. The experimental arm 6 post-test will be
completed by 166 participants and will require about 14 minutes to
complete. The total burden hours are estimated to be 838 hours.
Exhibit 2 shows the respondents' cost burden for their time to
participate in this experiment. The total cost burden is estimated to
be $16,142.
Exhibit 1--Estimated Annualized Burden Hours
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Number of
Experimental group Number of responses per Hours per Total burden
responses respondent response hours
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Clinician Choice Experiment:
Pretest..................................... 1,000 1 5/60 83
Experimental Web site....................... 1,000 1 10/60 167
Baseline/Control Post-test.................. 170 1 7/60 20
Experimental Arm 1 Post-test....... 166 1 8/60 22
Experimental Arm 2 Post-test....... 166 1 8/60 22
Experimental Arm 3 Post-test....... 166 1 12/60 33
Experimental Arm 4 Post-test....... 166 1 12/60 33
Experimental Arm 5 Post-test....... 166 1 14/60 39
Health Plan Choice Experiment:
Pretest..................................... 1,000 1 5/60 83
Experimental Web site....................... 1,000 1 10/60 167
Baseline/Control Post-test.................. 170 1 7/60 20
Experimental Arm 1 Post-test....... 166 1 8/60 22
Experimental Arm 2 Post-test....... 166 1 8/60 22
Experimental Arm 3 Post-test....... 166 1 12/60 33
Experimental Arm 4 Post-test....... 166 1 12/60 33
Experimental Arm 5 Post-test....... 166 1 14/60 39
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Total................................... 6,000 na na 838
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Exhibit 2--Estimated Annualized Cost Burden
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Number of Total burden Average hourly Total cost
Experimental group responses hours wage rate* burden
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Clinician Choice Experiment:
Pretest..................................... 1,000 83 $19.26 $1,599
Experimental Web site....................... 1,000 167 19.26 3,216
Baseline/Control Post-test.................. 170 20 19.26 385
Experimental Arm 1 Post-test....... 166 22 19.26 424
Experimental Arm 2 Post-test....... 166 22 19.26 424
Experimental Arm 3 Post-test....... 166 33 19.26 636
Experimental Arm 4 Post-test....... 166 33 19.26 636
Experimental Arm 5 Post-test....... 166 39 19.26 751
Health Plan Choice Experiment:
Pretest..................................... 1,000 83 19.26 1,599
Experimental Web site....................... 1,000 167 19.26 3,216
Baseline/Control Post-test.................. 170 20 19.26 385
Experimental Arm 1 Post-test....... 166 22 19.26 424
Experimental Arm 2 Post-test....... 166 22 19.26 424
Experimental Arm 3 Post-test....... 166 33 19.26 636
Experimental Arm 4 Post-test....... 166 33 19.26 636
Experimental Arm 5 Post-test....... 166 39 19.26 751
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Total................................... 6,000 838 na 16,142
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*Based upon the mean of the average wages, National Compensation Survey: Occupational wages in the United States
2006, ``U.S. Department of Labor, Bureau of Labor Statistics.''
Estimated Annual Costs to the Federal Government
The total cost to the Federal Government for developing and
conducting both the health plan and clinician choice components of this
study is $844,000, including the cost of designing the experiments,
developing the simulated Web-based reports, conducting usability
testing of the Web-reports, pilot testing the experiment, collecting
the data, analyzing the data, preparing reports and papers for journal
submission, and the cost for AHRQ staff
[[Page 51487]]
to oversee the project; see Exhibit 3. The annualized cost for this two
year project is $422,000.
Exhibit 3--Project Cost Components
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Cost
Cost components estimate
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Experimental design......................................... $168,900
Development of simulated Web-based reports.................. 157,900
Pilot testing............................................... 56,000
Usability testing of Web-based reports...................... 56,300
Data collection via Knowledge Networks...................... 126,000
Data analysis............................................... 56,300
Preparation of reports and journal papers................... 112,600
AHRQ project management................................. 110,000
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Total................................................... 844,000
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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 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: August 26, 2008.
Carolyn M. Clancy,
Director.
[FR Doc. E8-20315 Filed 9-2-08; 8:45 am]
BILLING CODE 4160-90-M