fast track PRA submission short form Provider Focus Group

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0935-0124)

TITLE OF INFORMATION COLLECTION: Provider Focus Group

PURPOSE:

The eCP apps were developed to allow primary care providers to perform person-centered care planning. To evaluate the degree to which the apps support this planning, up to 20 clinicians will be engaged in the clinician-facing app evaluation. Over the course of 3 to 6 months, we will engage specific clinicians from OHSU and other clinics to include primary care clinicians and specialty clinicians, such as geriatricians and nephrologists, to participate in a series of focus groups and/or interviews to gather requirements for and ultimately evaluate the clinician-facing application.

Over the course of three focus groups, providers will be asked to explore the following concepts:

• Integration of eCare Planner app into workflow,

• Usefulness of app to meet care coordination needs,

• How they used the eCare Planner app,

• Degree to which providers trusted the data in the eCare Planner app,

• Overall opinions of the eCare Planner app,

• Appropriateness of the data included in the eCare Planner app,

• Accuracy of the data included in the eCare Planner app, and

• Feasibility and ease of use by different members of the healthcare team

DESCRIPTION OF RESPONDENTS:

Clinicians working in primary care, gerontology, nephrology, and related clinical areas in the Portland, Oregon area.

TYPE OF COLLECTION: (Check one)

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

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

[X ] Focus Group [ ] Other: ______

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:______________Jacqueline Ortiz__________________________________

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 [X] No

Gifts or Payments:

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

Respondents will receive a $100 Amazon gift card to incentivize their efforts. The rate of $100/hour has been used for prior study with similar clinician population and is close to the $57.21/hour listed for the mean wages for 29-1000 Healthcare Diagnosing or Treating Practitioners (National Compensation Survey: Occupational wages in the United States May 2022).

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals	20	1.5 hours	30 hours
Totals	20	1.5 hours	30 hours

FEDERAL COST: The estimated annual cost to the Federal government is $3,000.

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? [ ] Yes [X] 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?

Providers will be recruited based on referrals by clinician champions named in the project proposal. Priority will be given to clinicians with experience treating the MCC population. Recruitment efforts for clinician participants will aim to ensure a diverse sample demographically and in regard to specialty and professional experience.

Administration of the Instrument

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

[ ] Web-based or other forms of Social Media

[ ] Telephone

[X ] In-person

[ ] Mail

[ ] Other, Explain

1.a. Percentage reporting electronically [0]

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

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

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 (in minutes) 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 Respondents and the Participation Time then 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.

6