Generic Request_VISN 22 Patient Perceptions

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 2900-0770)

TITLE OF INFORMATION COLLECTION:

Understanding Patient Perceptions of Access in VISN 22

PURPOSE: VISN 22 primary care leaders and some national PACT analyses have found a discontinuity between “actual access”, measured as third next available appointment or same day access to primary care from VSSC, and patients’ reports of access as measured via SHEP. VISN 22 primary care leaders have suggested several possible reasons for this discontinuity; for example, patients may prefer in-person visits with their assigned PCP, but may instead be accessing the PACT team led through virtual modalities. Or, patients’ views of access may be impacted if they have to call the VA several times to schedule an appointment. To understand the sources of disparity between actual access and patients’ perceptions of access, we propose to conduct brief telephone interviews with 50 patients receiving care in 5 VISN 22 primary care practices. The potential interviewees will be mailed the Q&A addendum (information about the purpose of the interview and their participation in it) along with an invitation to participate in the interview. The results of the analysis will be summarized and used to develop QI projects to improve access and/or further evaluation of factors affecting patients’ perceptions of access. VAIL will provide a summary of results, and will consult with the VISN 22 Primary Care Committee and/or Community of Practice on the development of interventions to address patient-perceived barriers to access. The interviews would begin in Q3 FY18, and would be supported with VAIL demonstration lab resources, and will be conducted as an operations project in collaboration with the VISN 22 Primary Care Committee.

DESCRIPTION OF RESPONDENTS: VHA patients with at least one primary care visit in the past 6 months at one of 5 VISN 22 primary care practices. To be eligible, patients must be in good enough health to participate in a 30-minute telephone interview, and must have tried to access VA for an urgent medical concern/condition.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [X] Other: _Telephone interviews___

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: Lisa Edwards, Project Manager__________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [X] Yes [ ] No

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [X] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No N/A

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [X]Yes [ ] No

Each participant will receive a $20.00 CVS gift card.

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time ( × minutes =)	Burden (÷ 60 =)
Individuals & Households	50	30	25 hours
	0	0	0
Totals	50 brief telephone interviews	30 minutes	25 hours

FEDERAL COST: The estimated annual cost to the Federal government is _$0_

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [X] Yes [ ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

We will use a 2-stage sampling procedure, first selecting primary care sites and then selecting patients within sites. Of primary interest are sites that are experiencing discordance between administrative measures of access and patients’ perceptions of access. Inclusion criteria for sites are: 1) below the VISN 22 average for established patient wait time in days; 2) below the VISN 22 average for percent of patients reporting same/one day access to urgent care; 3) non-contract clinic. In addition, we excluded the clinic site that participated in the pilot investigation described above, as we plan to include the interview data already collected from that site in our analyses. Thirteen sites met these criteria. To ensure representation from clinics of varying size, we stratified the clinics meeting these criteria by small (0-5,000 unique patients), medium (5,000 – 12,000), and large (over 12,000). We also wanted to ensure representation from rural sites, but only one rural site met the above three criteria. (We found most rural sites do not experience mismatch between administrative access measures and patient perceptions of access). From these strata, we will randomly select 2 small, 1 medium, and 2 large clinics. (NOTE: the pilot site will be included as a second medium-sized site.)

From the 5 selected sites, we will stratify patients by gender (male and female) and age (under 45, 45-64, 65 and over) and randomly select patients with a primary care visit in the past 6 months until we meet the following quota: 2 females under 45, 2 females 45-64, 1 female 65 and over, 2 males under 45, 2 males 45-64, and 1 male 65 and over (10 patients per site, 50 patients total). We will randomly select 150 patients per site (25 per each of the 6 age/gender strata). Within strata, the selected patients will be randomly ordered and invited in batches of 5 until the quotas listed above are filled. If one or more strata do not have 25 patients, we may allocate the remainder to other strata. To be eligible for the interview, patients must have had at least 1 urgent care visit in the past 6 months (eligibility to be determined by telephone screening.)

Selected patients will be recruited as follows. First, we will mail an invitation to participate in the interview as well as the Q&A addendum (information about the purpose of the interview and their participation in it) to their residence address (as recorded in VA administrative records) asking them to participate in the interview. The letter will include information about the purpose of the interview as well as a contact phone number for them to call to participate (or decline participation). Approximately one week after sending the letters, we will call the selected patients to invite them to participate in the interview. If the Veteran agrees and is available to be interviewed, the interviewer will conduct a brief screening to determine if the s/he has in the past 6 months tried to get an appointment with his/her PCP for something that s/he needed to be seen for right away (i.e., an urgent health concern). The purpose of the screening would be to ensure that the patient had attempted to get care right away from the VA in the recent past (past 6 months), could articulate his/her experience with attempting to access VA care, and was willing to talk to us about that experience. If the patient is deemed eligible for the interview, the interviewer will either conduct the interview or schedule a time with the patient to call back and conduct the interview.

This recruitment method has been used previously for the PACT Intensive Management pilot program evaluation, and resulted in higher than anticipated response rates (overall 81%).

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[X] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [X] Yes [ ] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

Attachments:

1. Interview Invitation Letter

2. Patient Perceptions of Access Interview Guide

3. Question and Answer addendum

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)

PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.

TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions. Note: Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households;(2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected per row.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of responses and the participation time and divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

Submit all instruments, instructions, and scripts are submitted with the request.

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