[Federal Register: January 15, 2009 (Volume 74, Number 10)]
[Notices]
[Page 2596-2598]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr15ja09-108]
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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: ``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 of effectiveness (e.g to what degree did a
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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).
Each of the six hospitals will submit information on the
costs associated with the planning, implementation, and maintenance of
the patient flow improvement strategies on a monthly basis. One study
team member at each site will record costs on an assessment instrument
specifically designed for this purpose and tailored to each hospital's
own organizational structure and patient flow strategies.
This assessment instrument will collect information on staff time
devoted to the patient flow improvement initiatives as well as the
costs of items or resources purchased to support the initiatives.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
hospitalst 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.
Monthly cost assessment data will be collected from each participating
hospital each month and will require about one hour. The total
estimated burden for participation in this study is 198 hours.
Exhibit 2 shows the estimated annualized cost burden for the
respondents' time to provide the requested data. The total cost burden
is approximately $6,536.
Exhibit 1--Estimated Annualized Burden Hours
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Number of
Data collection Number of responses per Hours per Total burden
respondents respondent response hours
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In-person interviews............................ 6 12 1 72
Telephone interviews............................ 6 12 45/60 54
Cost Assessment................................. 6 12 1 72
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Total....................................... 18 na na 198
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Exhibit 2--Estimated Annualized Cost Burden
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Average
Data collection Number of Total burden hourly wage Total cost
respondents hours rate* burden
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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
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Total....................................... 18 198 na 6,536
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* 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
this eighteen-month study.
Exhibit 3--Estimated Cost
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Annualized
Cost component Total cost cost
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Project Development..................... $52,446 $34,964
Data Collection Activities.............. 90,298 60,199
[[Page 2598]]
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
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Total............................... 399,961 266,641
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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'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: December 30, 2008.
Carolyn M. Clancy,
Director.
[FR Doc. E9-537 Filed 1-14-09; 8:45 am]
BILLING CODE 4160-90-M