View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0935-0265
ICR Reference No:
202303-0935-001
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/AHRQ
Agency Tracking No:
Title:
The AHRQ Safety Program for Telemedicine: Improving the Diagnostic Process and Improving Antibiotic Use
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
04/21/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/20/2023
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2026
36 Months From Approved
Responses
11,100
0
0
Time Burden (Hours)
5,581
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
This program aims to improve two at-risk areas among telemedicine practices by implementing the AHRQ- and Johns Hopkins Armstrong Institute for Patient Safety and Quality (JHAI)-developed Comprehensive Unit-based Safety Program (CUSP) approach: 1) the diagnostic process for breast, colorectal, and lung cancer; and 2) antibiotic stewardship (AS). The CUSP approach improves safety culture at the practice level, enables harm prevention, and engages providers who are on the front lines while integrating technical and adaptive/cultural approaches to making sustainable change. This program constitutes the first large-scale implementation of a quality improvement effort for the cancer diagnostic process and AS in telemedicine. Given the need for clearer guidance and evidence-based telemedicine practices for clinicians and potential for positive impact on outcomes, as described below, these two areas were chosen.
Authorizing Statute(s):
US Code:
42 USC 299b-2
Name of Law: Health Care Quality Act of 1999
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
87 FR 76621
12/15/2022
30-day Notice:
Federal Register Citation:
Citation Date:
88 FR 13119
03/02/2023
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
9
IC Title
Form No.
Form Name
Antibiotic Prescription Data Template_Antibiotic Stewardship Cohort
11
Attachment K: Antibiotic Prescription Data Template_Antibiotic Stewardship Cohort
Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort
10
Attachment J: Clinical Data Collection Instrument_Cancer Diagnostic Process Cohort
Diagnostic Safety Supplement
5
Attachment E: Diagnostic Safety Supplement
Interview Guide for Semi-Structured Interviews
9, 8
Attachment H: Draft Interview Guide for Semi-Structured Interviews_ Cancer Diagnostic Process Cohort
,
Attachment I: Draft Interview Guide for Semi-Structured Interviews_Antibiotic Stewardship Cohort
Participant Experience Survey_Antibiotic Stewardship Cohort
7
Attachment G: Participant Experience Survey_Antibiotic Stewardship Cohort
Participant Experience Survey_Cancer Diagnostic Process Cohort
6
Attachment F: Participant Experience Survey_Cancer Diagnostic Process Cohort
Structural Assessments
1, 2
Attachment A: Structural Assessment_Cancer Diagnostic Process Cohort
,
Attachment B: Structural Assessment_Antibiotic Stewardship Cohort
The Medical Office Survey on Patient Safety Culture (MOSOPS)
4
Attachment D: The Medical Office Survey on Patient Safety Culture (MOSOPS)
The Office Readiness Survey_Cancer Diagnostic Process Cohort
3
Attachment C: The Office Readiness Survey_Cancer Diagnostic Process Cohort
ICR Summary of Burden
Total Approved
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
11,100
0
0
11,100
0
0
Annual Time Burden (Hours)
5,581
0
0
5,581
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:
This is a new Information Collection Request
Annual Cost to Federal Government:
$907,956
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.
No
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.
Yes
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
Agency Contact:
Michelle Roberts 301 427-1645 michelle.roberts@ahrq.hhs.gov
Common Form ICR:
No
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:
03/20/2023
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