Medical Office Survey on Patient Safety Culture Comparative Database

Forms and Documents

Document Name	Status
Form Form #4 Data Submission Form	Modified
Form Form #3 Medical Office Information Form Form	Modified
Form Form #2 Data Use Agreement Form and Instruction	Modified
Form Form #1 Eligibility Form Form	Modified
Supporting Statement Part B -- MOSOPS_Renewal_1-13-21.docx Supporting Statement B	2021-08-25
Attachment F - SOPS Databases TEP List.doc Supplementary Document	2015-07-27
Attachment G - Example Screenshots.docx Supplementary Document	2015-07-27
Attachment E - Medical Office Survey Data File Specifications.pdf Supplementary Document	2015-07-27
Attachment D - Medical Office Data Submission Emails_revised 8-5-15.docx Supplementary Document	2015-08-21
Supporting Statement Part A -- MOSOPS_Renewal 1-13-21 EC.docx Supporting Statement A	2021-09-02

IC Document Collections

IC ID	Document Title	Status
201169	Data Submission Form	Modified
201168	Medical Office Information Form Form	Modified
201167	Data Use Agreement Form and Instruction	Modified
201166	Eligibility Form Form	Modified

ICR Details

OMB Control No: 0935-0196	ICR Reference No: 202108-0935-001
Status: Received in OIRA	Previous ICR Reference No: 201807-0935-002
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Medical Office Survey on Patient Safety Culture Comparative Database
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/07/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	09/30/2021
Responses	3,230	2,660
Time Burden (Hours)	341	282
Cost Burden (Dollars)	0	0

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Abstract: Background on the Medical Office Survey on Patient Safety Culture (Medical Office SOPS). In 1999, the Institute of Medicine called for health care organizations to develop a “culture of safety” such that their workforce and processes focus on improving the reliability and safety of care for patients (IOM, 1999; To Err is Human: Building a Safer Health System). To respond to the need for tools to assess patient safety culture in health care, AHRQ developed and pilot tested the Medical Office Survey on Patient Safety Culture with OMB approval (OMB NO.0935-0131; Approved July 5, 2007). The survey is designed to enable medical offices to assess provider and staff perspectives about patient safety issues, medical error, and error reporting. The survey includes 38 items that measure 10 composites of patient safety culture. In addition to the composite items, 14 items measure staff perceptions how often medical offices have problems exchanging information with other settings as well as other patient safety and quality issues. AHRQ made the survey publicly available along with a Survey User’s Guide and other toolkit materials in December 2008 on the AHRQ website . The AHRQ Medical Office SOPS Database consists of data from the AHRQ Medical Office Survey on Patient Safety Culture and may include reportable, non-required supplemental items . Medical offices in the U.S. can voluntarily submit data from the survey to AHRQ, through its contractor, Westat. The Medical Office SOPS Database (OMB NO. 0935-0196, last approved on September 10, 2018) was developed by AHRQ in 2011 in response to requests from medical offices interested in tracking their own survey results. Those organizations submitting data receive a feedback report, as well as a report of the aggregated, de-identified findings of the other medical offices submitting data. These reports are used to assist medical office staff in their efforts to improve patient safety culture in their organizations. Rationale for the information collection. The Medical Office SOPS and the Medical Office SOPS Database support AHRQ’s goals of promoting improvements in the quality and safety of health care in medical office settings. The survey, toolkit materials, and database results are all made publicly available on AHRQ’s website. Technical assistance is provided by AHRQ through its contractor at no charge to medical offices, to facilitate the use of these materials for medical office patient safety and quality improvement.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 23369	05/03/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 47312	08/24/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Data Submission	Form #4	Example Screen Shots of Web Site Information Collection
Data Use Agreement	Form #2	Medical Office SOPS Database Data Use Agreement
Eligibility Form	Form #1	Medical Office SOPS Database Eligibility Form
Medical Office Information Form	Form #3	Medical Office Information Form

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,230	2,660	0	570	0	0
Annual Time Burden (Hours)	341	282	0	59	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The estimated number of POCs increased from 70 in the previous information collection request (ICR) to 85 in this ICR. As a result of more POCs submitting data for fewer sites, the total burden hours have increased slightly from 283 to 341.5.

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Annual Cost to Federal Government: $220,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/07/2021

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