SupportingStatementEisenbergCenterGenericClearance02-2007

Eisenberg Center Clearance 5-2-2006 rev 5-23, 6-13, 8-15

SUPPORTING STATEMENT

Eisenberg Center

Voluntary Customer Survey Generic Clearance

for the Agency for Healthcare Research and Quality

OMB No. 0935-_____

A. JUSTIFICATION

1. Need for Information

The Agency for Healthcare Research and Quality (AHRQ) requests that the Office of Management and Budget (OMB) approve under the Paperwork Reduction Act of 1995 AHRQ’s intention to collect information from users of work products and services initiated by the John M. Eisenberg Clinical Decisions and Communications Science Center (Eisenberg Center).

AHRQ is the lead agency charged with supporting research designed to improve the quality of healthcare, reduce its cost, improve patient safety, decrease medical errors, and broaden access to essential services. AHRQ’s newly-established Eisenberg Center is an innovative effort aimed at improving communication of findings to a variety of audiences (“customers”), including consumers, clinicians, payers, and health care policy makers. The Eisenberg Center compiles research results into a variety of useful formats for customer stakeholders. The Eisenberg Center also conducts its own program of research into effective communication of research findings in order to improve usability and rapid incorporation of findings into medical practice. The Eisenberg Center, one of three components of AHRQ’s Effective Health Care Program announced in September 2005, is directed by the Oregon Health and Science University, Department of Medicine, located in Portland, Oregon.

The purpose of the collections to be proposed under this clearance include activities to assist in the development of materials to be disseminated through the Eisenberg Center and to provide feedback to the AHRQ on the extent to which these products meet customer needs. Information collections conducted under this generic clearance are not required by regulation and will not be used to regulate or sanction customers. Surveys will be entirely voluntary, and information provided by respondents will be combined and summarized so that no individually identifiable information will be released.

In accordance with OMB guidelines for generic clearances for voluntary customer surveys and Executive Order 12862, AHRQ has established an independent review process to assure the development, implementation, and analysis of high quality customer surveys within AHRQ. Specifically, AHRQ understands that each activity conducted must be submitted to OMB as a change request, with a supporting statement and accompanying instruments. Information collection may not proceed until approved by OMB. An annual summary of activities conducted under this clearance will be provided to OMB on the anniversary of the approval date.

2. How, by Whom, and for What Purpose Information Will Be Used

Information will be collected via focus groups, voluntary automated/web-based surveys, personal interviews and cognitive laboratory testing by Eisenberg Center staff to identify strengths and weaknesses in products and services to make improvements that are practical and feasible. This information will be used to improve or maintain high quality products and services to the lay and health professional public.

3. Use of Improved Information Technology

Improved electronic technology (e.g., Web-based materials) will be used whenever possible to reduce the burden on the public. In some instances, however, the most appropriate methodology will involve written or oral responses to brief questionnaires, interviews, and focus groups.

4. Efforts to Identify Duplication

Each survey will be designed to reflect the specifics of the customer population served. During the development of these voluntary instruments, numerous groups within and outside of AHRQ will be consulted. Plans to conduct surveys will be reviewed prior to implementation, and any potential duplication will be identified in the review and approval process.

5. Small Businesses

The survey instruments and procedures for completing the instruments will be designed to minimize burden on all respondents and will not have a significant impact on small businesses or other small entities. The burden is entirely voluntary.

6. Consequences of Less Frequent Collection

Information collections are appropriate vehicles to examine customer experiences and perceptions with products and services developed by the Eisenberg Center and its ability to effectively improve communications for a variety of audiences. Collection of data on a less frequent basis would reduce the practical utility of the information and would inhibit the Eisenberg Center’s ability to determine how well its products and services are meeting customers’ current and anticipated needs; to identify problem areas with existing products and services and determine what improvements should be made to improve these products and services; and to identify and develop new products and services.

7. Consistency with the Guidelines in 5 CFR 1320.5(d)(2)

The data collection efforts will be consistent with the guidelines at 5 CFR 1320.5(d)(2).

8. Comments in Response to the Federal Register Notice and Efforts to Consult Outside the Agency

The Eisenberg Center will consult with AHRQ’s in-house statistical staff, other Federal agencies, and other organizations, which have conducted, or may conduct, similar surveys to identify areas of interest and concern to customers. As appropriate, panels of outside experts may be established to assist in design and implementation of the surveys.

No comments were received on the Federal Register notices issues in connection with this action. The 60-day Federal Register notice was published in Vol. 71, No. 128 on Wednesday, July 5, 2006, page 38167. The 30-day Federal Register notice was published in Vol. 71, No. 176 on Tuesday, September 12, 2006, page 53695.

9. Remuneration of Respondents

No remuneration to respondents for written, telephone, web, or other forms of surveys or interviews will be given. On a case-by-case basis, consideration will be given for modest remuneration for participants in focus groups. This remuneration is meant to reimburse the participants for their time and travel. In such cases, the remuneration will not exceed $50 per individual and the same remuneration will be offered to all persons participating in the activity. Remuneration for focus group participation is a recognized standard industry practice, without which, it would be difficult to achieve appropriate and adequate participation. Specific proposed remuneration will be included in the supporting statement for specific activities under this generic clearance.

10. Assurance of Confidentiality

Respondents will be advised that surveys are entirely voluntary and that any information they provide will be combined and summarized with information provided by others and no individually identifiable information will be released. In instances where respondent identity is needed, the information collection will fully comply with all respects of the Privacy Act.

11. Questions of a Sensitive Nature

No questions of a sensitive nature are anticipated under this generic clearance.

12. Estimates of Annualized Hour Burden

The estimated annual hour burden is as follows:

Type of Survey	Number of Respondents	Average Hours per Response	Total Hours	Wage Rate*	Total Cost
Focus groups for needs assessment	30	1	30	*	$0
Individual interviews for needs assessment	50	.75	37.5	$20	$750
Formative focus groups for information tools	120	1	120	*	$0
Cognitive testing of information tools	500	1	500	$10	$5,000
Clinician interviews for information tools	160	.75	120	$25	$3,000
Decision aid laboratory testing	100	1	100	$10	$1,000
Formative focus groups for decision aids	60	1	60	*	$0
Web or telephone customer surveys	300	.163	48.9	$25	$1,222
Totals	1,320	NA	1,015.9	NA	$10,972

*Note: There is no cost to focus group participants inasmuch as it is customary to pay participants a small honorarium, typically $50, in consideration for their participation and their transportation costs.

Draft samples of several potential collections are included in the appendix to this document.

13. Estimates of Annual Cost Burden to Respondents

Costs to respondents will be limited to their time to provide the requested information. Based on the hourly rates and the annual total burden of 1,186 hours for the data collection activities, the annual cost to respondents is anticipated to be $14,700. As noted in the annualized burden table in item 12, there is no cost to focus group participants inasmuch as it is customary to pay participants a small honorarium, typically $50, in consideration for their participation and their transportation costs.

14. Estimates of Annualized Cost to the Government

The maximum cost to the Federal Government is $750,000 annually for FY 2007, FY 2008, and FY 2009. Most of the work will be carried out under contract. The costs were estimated at $200 for each face-to-face interview, $100 for each telephone interview, $5,000 for each focus group, $10,000 for web-based surveys, and $20,000 for each laboratory testing module.

15. Change in Burden

Not applicable. This is a new clearance.

16. Plans for Analyses

The purposes of these information collections are to conduct cognitive testing of Eisenberg Center products prior to their broad dissemination to insure that they will meet the needs of their customers and to collect information on how customers use the products once they have been disseminated.

The analyses will be descriptive and unlikely to be able to be generalized. The results of these findings are primarily for internal use but may be shared with key government policy and management officials, AHRQ staff, public and private health providers, and members of the general public.

Focus groups: Participants will be selected purposively, so that no generalizations to the population will be possible. Focus groups will be used to identify problems and issues for further study and, in some instances, "brainstorm" for possible solutions. The analyses will be qualitative and consist mostly of narrative summaries of the discussions. We anticipate that focus groups would be used to provide input into assessing the needs for products and for the development of decision aids and information tools

Decision aid laboratory testing: Laboratory testing will, under a controlled environment, systematically evaluate different products in order to refine and enhance their readability, comprehension, and usefulness. The laboratory studies allow the investigator to vary features of reports or conditions in a systematic way to facilitate evaluation of those features or conditions. Characteristics of respondents needed for a laboratory study are identified and respondents recruited for participation in the study. Respondents usually come to a central location where they are presented with the instructions for the study. They are then exposed to the study material and asked to respond to a series of questions that will allow the investigators to assess the report features or conditions.

Cognitive testing of information tools: Cognitive interviews are used to assess the understandability and usefulness of draft material. Cognitive interviewing is a qualitative method in which individuals are asked to verbalize thoughts and feelings as they read through text materials. This technique is used to discover problems with draft information materials. By asking the interviewee to “think out loud” while reviewing written materials, the interviewer can gain insight into the cognitive processes of the reader. By conducting one-on-one interviews, individuals are afforded the privacy and flexibility that are needed to allow them to discuss reactions, reveal interpretations, and communicate how they might use the material in decision making.

Customer surveys: Electronic technology may be used for this type of information collection. It will be mounted on the website for voluntary response as an electronic evaluation form. In addition to summarizing responses to questions, basic demographic information will be collected and summarized. On occasion, similar information may be collected from customers over the phone to insure we obtain information from customers who do not use the web frequently.

17. Exemption for Display of Expiration Date

No exemption is being requested.

18. Certifications

These activities will comply with the requirements of 5 CFR 1320.9.

STATISTICAL METHODS

1. Potential Respondent Universe and Sample Selection Method

Given the purposeful nature of the activities it is unlikely that statistical measures will be generally employed.

In some instances, however, there will be an existing list of "customers" readily available for sampling (e.g., mailing lists for publications or recipients of particular materials or services within known customer groups). Appropriate probability sampling techniques will be used to select samples.

2. Information Collection Procedures

All information collections will be conducted in a manner that is consistent with the following guidelines:

• Participation will be fully voluntary, and non-participation will have no effect on eligibility for, or receipt of, future AHRQ-sponsored health services research.

• Appropriate sample sizes will be determined for each activity to ensure that burden is minimized while reliable estimates are produced.

• Information collection will be limited to that needed to assess customer reaction to AHRQ products and services.

• Given the voluntary nature of the information collections, efforts will be made to obtain the highest possible response rates. Efforts will also be made to assess non-response bias, to the extent feasible.

3. Methods to Maximize Response Rate

The design of each information collection will include approaches to maximize response rates, while retaining the voluntary nature of the effort, consistent with appropriate survey methodology. Additional formal pretesting will be carried out at a level and in a manner consistent with the specific survey.

4. Tests of Procedures

It is anticipated that most information collections will begin with efforts by Eisenberg Center staff or in some cases by focus groups to identify the views/concerns of customers. Most formal pretesting will be carried out at a level and in a manner consistent with the specific survey.

5. Statistical Consultation and Independent Review

Input from statisticians regarding the development, design, conduct, and analysis of information collections will be sought. This statistical expertise will be available from AHRQ statisticians/contractors. Technical assistance in survey design and statistics may, in some cases, be sought through The National Center for Health Statistics.

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