81 FR 7116 - Request for Measures Assessing Health Care Organization Quality Improvement Activities To Improve Patient Understanding, Navigation, Engagement, and Self-Management
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality Federal Register Volume 81, Issue 27 (February 10, 2016)
Agency for Healthcare Research and Quality
Federal Register Volume 81, Issue 27 (February 10, 2016)
| Page Range | 7116-7118 | |
| FR Document | 2016-02679 |
[Federal Register Volume 81, Number 27 (Wednesday, February 10, 2016)] [Notices] [Pages 7116-7118] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2016-02679] ======================================================================= ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Request for Measures Assessing Health Care Organization Quality Improvement Activities To Improve Patient Understanding, Navigation, Engagement, and Self-Management AGENCY: Agency for Healthcare Research and Quality (AHRQ), DHHS. ACTION: Notice of request for measures. ----------------------------------------------------------------------- SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) requests information from the public (including health care delivery organizations, health information developers, payers, quality measure developers, clinicians, and health care consumers) about quality improvement measures designed to help health care organizations monitor initiatives aimed at:Improving patient understanding of health information, simplifying navigation of health care systems and facilities, and enhancing patients' ability to manage their health. Specifically, AHRQ seeks quality improvement measures in four domains: 1. Communication, 2. Ease of Navigation, 3. Patient Engagement and Self-Management, and 4. Organizational Structure, Policy, and Leadership. AHRQ is interested in measures that do not require patient survey data and that health care organizations are currently using, or have used in the past, to guide quality improvement activities designed to address these domains. AHRQ is also interested in information about relevant measures that are under development or are suggested for future development. DATES: Please submit one or more quality improvement measures and supporting information on or before March 4, 2016. AHRQ will not respond individually to submitters, but will consider all submitted measures and publicly report the results of the review of the submissions in aggregate. ADDRESSES: Submissions should follow the Submission Instructions below. Electronic responses are preferred and should be addressed to [email protected]. Non-electronic responses will also be accepted. Please send these by mail to: Cindy Brach, Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, 5600 Fisher Lane, Rockville, MD 20857, Mailstop: 07W25B. [[Page 7117]] FOR FURTHER INFORMATION CONTACT: [email protected] or Cindy Brach at the address above. SUPPLEMENTARY INFORMATION: Background Information The health care system is complex and demanding. Health care organizations can help patients to succeed in the health care environment by ensuring that patients and caregivers are able to understand health information, navigate the health care system, engage in the health care process, and take an active and effective role in the management of their health. This Request for Measures is part of a project that aims to: Identify existing measures that organizations use or could use to monitor progress related to the four domains described above; and, Refine and cull identified measures to establish a set of measures that reflects patient priorities, has expert support, and will be recommended for more formal measure development and testing. The project focuses on identifying measures that are not generated from patient survey data. The project is guided by a conceptual framework that builds on the concept of organizational health literacy. As described in the Institute of Medicine's Roundtable on Health Literacy, organizational health literacy is the ``implementation and monitoring of organizational policies, practices, and structures that support patients in understanding health information, navigating the health care system, and managing their health'' (Brach et al. 2012). The conceptual framework identifies four domains as key components of organizational health literacy. 1. Communication (e.g., the quality of verbal and written communication with patients, families, caregivers) 2. Ease of Navigation (e.g., the degree to which an organization's physical environment and systems of care are designed in a manner that simplifies navigation and use of services) 3. Patient Engagement and Self-Management (e.g., the degree to which an organization encourages patient engagement and provides support to enhance the ability of patients to manage their health) 4. Organizational Structure, Policy, and Leadership (e.g., leadership support for organizational health literacy; implementation of policies, procedures, and structures that serve to improve communication with patients, simplify patient navigation, and enhance patient engagement and self-management) Quality improvement measures selected for further measure development and testing will assess key features of one or more of these domains. This project is being conducted by AHRQ pursuant to its statutory authority to conduct and support research on healthcare and on systems for the delivery of such care, including activities with respect to quality measurement and improvement. 42 U.S.C. 299a(a)(2). Submission Guidance Submit a measure(s) that is currently in use, in development, or for which a need has been identified, in one or more of the four domains (i.e., Communication; Ease of Navigation; Patient Engagement and Self-Management; and Organizational Structure, Policy, and Leadership). For this Request for Measures, AHRQ is specifically interested in measures that do not require or use patient reported data obtained using a patient survey. Your contribution will be very beneficial to AHRQ. The contents of all submissions will be made available to the public upon request. Materials submitted must be publicly available or can be made public. Materials that are considered confidential and marketing materials cannot be used by AHRQ. This is a voluntary request for information, and all costs for complying with this request must be borne by the submitter. AHRQ and its contractor, will evaluate all submitted measures and supporting documentation. As a set of measures is identified and evaluated for further refinement and testing, submissions may be included in whole or in part or may be modified for inclusion in the measurement set. AHRQ will assume responsibility for the final measurement sets as well as any future modifications. Submission Instructions To facilitate handling of submissions, please include the name and email address of the measure developer or contact. The responses most helpful to the Agency will include all or most of the following: 1. A brief cover letter, 2. a description of the measure and how it is calculated (e.g., who/what is included in the numerator, who/what is included in the denominator, who/what is excluded in calculating the measure), 3. the source of the measure (e.g., publications, organizations where measure has been used to guide quality improvement activities), 4. the domain best aligned with the measure (i.e., Communication; Ease of Navigation; Patient Engagement and Self-Management; and Organizational Structure, Policy, and Leadership), 5. the source of data used to calculate the measure (e.g., electronic health records, internal monitoring and reporting systems), 6. a description of data collection strategies (e.g., who is responsible for data collection, how is the information needed to calculate the measure collected), 7. a list of health care settings in which the measure has been or would be used and characteristics of the patient populations in these health care settings, 8. a description of how the measure has been used to support performance improvement (e.g., to whom is the measure reported, what actions have been taken based on the measure), 9. a summary of unintended negative consequences resulting from use of the measure (e.g., evidence that implementation of the measure has negatively impacted patients, staff, clinical process, or other features of the implementing organization), and 10. evidence that the measure is: a. Valid and reliable, b. associated with important outcomes, c. meaningful to patients, families, clinicians, and/or administrators, d. feasible to compute with accuracy and without undue cost, burden, or delay, and e. generalizable across health care settings. 11. title, author(s), publication year, journal name, volume, issue, and page numbers of cited articles. 12. a statement of willingness to grant to AHRQ the right to use and disseminate submitted measures and their documentation to the public as part of a set of organizational health literacy measures. Submission of copies of existing documentation or reports describing the measure and its properties, existing data sources, etc. is highly desirable but not required. Reference Material Brach, C., Keller, D., Hernandez, L.M., et al. (2012). Ten attributes of a health literate health care organization. Washington DC: Institute of Medicine. Kripalani, S., Wallston, K., Cavanaugh, K.L., Osborn, C., Mulvaney, S., Scott, A.M., & Rothman, R.L. (2014). Measures to assess a health-literate organization. [[Page 7118]] Washington DC: Institute of Medicine. Sharon B. Arnold, Deputy Director. [FR Doc. 2016-02679 Filed 2-9-16; 8:45 am] BILLING CODE P
![7116 Federal Register / Vol. 81, No. 27 / Wednesday, February 10, 2016 / Notices
agency or other federal entity that RETENTION AND DISPOSAL: DEPARTMENT OF HEALTH AND
furnished the record or information for Records are retained and disposed of HUMAN SERVICES
the purpose of permitting that agency or in accordance with the General Records
entity to make a decision regarding Schedule 4.2, item 020, issued by the Agency for Healthcare Research and
access to or correction of the record or National Archives and Records Quality
information, or to a federal agency or Administration (NARA).
entity for purposes of providing Request for Measures Assessing
guidance or advice regarding the SYSTEM MANAGER(S) AND ADDRESS: Health Care Organization Quality
handling of a particular request. Improvement Activities To Improve
Chief FOIA Officer, 77 K Street NE., Patient Understanding, Navigation,
3. A record from this system of Washington, DC 20002.
records may be disclosed to the Engagement, and Self-Management
Department of Justice (DOJ) to obtain NOTIFICATION PROCEDURE: AGENCY: Agency for Healthcare Research
advice regarding statutory and other Individuals seeking to determine and Quality (AHRQ), DHHS.
requirements under the FOIA. whether this system of records contains ACTION: Notice of request for measures.
4. A record from this system of
information about themselves must
records may be disclosed to the National SUMMARY: The Agency for Healthcare
submit a written request to the FOIA
Archives and Records Administration, Research and Quality (AHRQ) requests
Officer, FRTIB, 77 K Street NE.,
Office of Government Information information from the public (including
Washington, DC 20002, and provide the
Services (OGIS), to the extent necessary health care delivery organizations,
following information:
to fulfill its responsibilities in 5 U.S.C. health information developers, payers,
552(h) to review administrative agency a. Full name; quality measure developers, clinicians,
policies, procedures, and compliance b. Any available information and health care consumers) about
with the FOIA, and to facilitate OGIS’s regarding the type of record involved; quality improvement measures designed
offering of mediation services to resolve c. The address to which the record to help health care organizations
disputes between persons making FOIA information should be sent; and monitor initiatives aimed at:
requests and administrative agencies. d. You must sign your request. • Improving patient understanding of
Attorneys or other persons acting on health information,
DISCLOSURE TO CONSUMER REPORTING
behalf of an individual must provide • simplifying navigation of health
AGENCIES:
written authorization from that care systems and facilities, and
None.
individual, such as a Power of Attorney, • enhancing patients’ ability to
POLICIES AND PRACTICES FOR STORING, in order for the representative to act on manage their health.
RETRIEVING, ACCESSING, RETAINING, AND their behalf. Individuals requesting Specifically, AHRQ seeks quality
DISPOSING OF RECORDS IN THE SYSTEM: access must also comply with FRTIB’s improvement measures in four domains:
1. Communication,
STORAGE: Privacy Act regulations regarding 2. Ease of Navigation,
Records are maintained in paper and verification of identity and access to 3. Patient Engagement and Self-
electronic form, including on computer such records, available at 5 CFR part Management, and
databases, all of which are stored in a 1630. 4. Organizational Structure, Policy,
secure location. and Leadership.
RECORD ACCESS PROCEDURE:
AHRQ is interested in measures that
RETRIEVABILITY: Same as Notification Procedures. do not require patient survey data and
Records are retrieved by any one or that health care organizations are
more of the following: The name of the CONTESTING RECORDS PROCEDURE:
currently using, or have used in the
requestor; the number assigned to the Same as Notification Procedures. past, to guide quality improvement
request or appeal; and in some activities designed to address these
instances, the name of the attorney RECORD SOURCE CATEGORIES:
domains. AHRQ is also interested in
representing the requestor or appellant, Records are obtained from those information about relevant measures
and/or the name of an individual who individuals who submit requests and that are under development or are
is the subject of such a request or administrative appeals pursuant to the suggested for future development.
appeal. FOIA or who file litigation regarding DATES: Please submit one or more
SAFEGUARDS: such requests and appeals; the agency quality improvement measures and
FRTIB has adopted appropriate record keeping systems searched in the supporting information on or before
administrative, technical, and physical process of responding to such requests March 4, 2016. AHRQ will not respond
controls in accordance with FRTIB’s and appeals; FRTIB employees assigned individually to submitters, but will
security program to protect the security, to handle such requests, appeals, and/or consider all submitted measures and
confidentiality, availability, and litigation; other agencies or entities that publicly report the results of the review
integrity of the information, and to have referred to FRTIB requests of the submissions in aggregate.
ensure that records are not disclosed to concerning FRTIB records, or that have ADDRESSES: Submissions should follow
or accessed by unauthorized consulted with FRTIB regarding the Submission Instructions below.
individuals. handling of particular requests; and Electronic responses are preferred and
submitters or subjects of records or
asabaliauskas on DSK9F6TC42PROD with NOTICES2
Paper records are stored in locked file should be addressed to HealthLiteracy@
cabinets in areas of restricted access that information that have provided AHRQ.HHS.gov. Non-electronic
are locked after office hours. Electronic assistance to FRTIB in making access or responses will also be accepted. Please
records are stored on computer amendment determinations. send these by mail to: Cindy Brach,
networks and protected by assigning EXEMPTIONS CLAIMED FOR SYSTEM:
Center for Delivery, Organization, and
usernames to individuals needing Markets, Agency for Healthcare
access to the records and by passwords None. Research and Quality, 5600 Fisher Lane,
set by unauthorized users that must be [FR Doc. 2016–02673 Filed 2–9–16; 8:45 am] Rockville, MD 20857, Mailstop:
changed periodically. BILLING CODE 6760–01–P 07W25B.
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![7118 Federal Register / Vol. 81, No. 27 / Wednesday, February 10, 2016 / Notices
Washington DC: Institute of Medicine. defined as ‘‘the degree to which to conduct and support research on
Sharon B. Arnold,
individuals have the capacity to obtain, health care and on systems for the
process, and understand basic health delivery of such care, including
Deputy Director.
information and services needed to activities with respect to the quality,
[FR Doc. 2016–02679 Filed 2–9–16; 8:45 am]
make appropriate health decisions.’’ 1 effectiveness, efficiency,
BILLING CODE P The effects of limited health literacy are appropriateness and value of health care
numerous and serious, including services and with respect to quality
medication non-adherence resulting measurement and improvement. 42
DEPARTMENT OF HEALTH AND from patients’ inability to read and U.S.C. 299a(a)(1) and (2).
HUMAN SERVICES comprehend medication labels;
underuse of preventive measures, such Method of Collection
Agency for Healthcare Research and
Quality as vaccines; poor self-management of Environmental Scan Interviews:
conditions such as asthma and diabetes; Representatives from 25 health care
Agency Information Collection and higher utilization of inpatient and organizations engaged in relevant
Activities: Proposed Collection; emergency department care. According quality improvement efforts will be
Comment Request to the 2003 National Assessment of interviewed to obtain information about
Adult Literacy, 88% of U.S. adults have the quality improvement measures they
AGENCY: Agency for Healthcare Research significant difficulties understanding use in assessing their work to improve
and Quality, HHS. widely used health information. By patient understanding, navigation,
ACTION: Notice. adopting ‘‘health literacy universal engagement, and self-care.
precautions,’’ health care providers and
SUMMARY: This notice announces the organizations can create an environment The planned environmental scan
intention of the Agency for Healthcare in which all patients—regardless of interviews will provide the information
Research and Quality (AHRQ) to request health literacy level—can successfully needed to:
that the Office of Management and (1) understand health information, (2) • Identify and document the
Budget (OMB) approve the proposed navigate the health care system, (3) characteristics of relevant quality
information collection project: ‘‘Making engage in medical decision-making, and improvement measures that are already
It Easier for Patients to Understand (4) manage their health. in use; and
Health Information and Navigate Health Numerous resources have been • identify additional measures that
Care Systems: Developing Quality developed to support health care would be useful to stakeholders in the
Improvement Measures.’’ In accordance organizations in their attempts to field.
with the Paperwork Reduction Act, 44 address limitations in patient health
U.S.C. 3501–3521, AHRQ invites the The findings from these interviews
literacy. However, little work has been
public to comment on this proposed will be used, along with the results from
done to establish valid quality
information collection. other activities (i.e., input from a
improvement measures that
Technical Expert Panel, literature
DATES: Comments on this notice must be organizations can use to monitor the
review, a Request for Information
received by April 11, 2016. impact of initiatives aimed at improving
published in the Federal Register, and
ADDRESSES: Written comments should patient understanding, navigation,
focus groups with patients), to identify
be submitted to: Doris Lefkowitz, engagement, and self-management.
and document a set of quality
Reports Clearance Officer, AHRQ, by Absent such measures, organizations
improvement measures that can be
email at doris.lefkowitz@AHRQ.hhs.gov. may be unable to accurately assess
recommended for rigorous testing and
Copies of the proposed collection whether their initiatives are effective.
This research has the following goals: validation. Measures that are assessed to
plans, data collection instruments, and
1. Identify existing quality be valid and reliable will be eligible to
specific details on the estimated burden
improvement measures and gather be disseminated by AHRQ to support
can be obtained from the AHRQ Reports
proposals for additional measures (not health care organizations in their efforts
Clearance Officer.
generated from patient survey data) that to improve patient understanding of
FOR FURTHER INFORMATION CONTACT: health information, navigation of the
Doris Lefkowitz, AHRQ Reports organizations may use to monitor
progress related to enhancing patient health care system, engagement in
Clearance Officer, (301) 427–1477, or by medical decision-making, and
email at doris.lefkowitz@AHRQ.hhs.gov. understanding, navigation, engagement,
and self-management; and management of their health.
SUPPLEMENTARY INFORMATION:
2. Identify a set of quality Estimated Annual Respondent Burden
Proposed Project improvement measures that reflect
patient priorities, has expert support, Exhibit 1 shows the estimated
Making It Easier for Patients To and can be recommended for more annualized burden hours for the
Understand Health Information and formal measure development and respondents’ time to participate in
Navigate Health Care Systems: testing. Environmental Scan Interviews. The
Developing Quality Improvement This project is being conducted by Environmental Scan Interviews will be
Measures AHRQ through its contractor, Board of completed by 50 respondents (2
A goal of Healthy People 2020 is to Regents of the University of Colorado, representatives from each of the 25
asabaliauskas on DSK9F6TC42PROD with NOTICES2
increase Americans’ health literacy, pursuant to AHRQ’s statutory authority organizations targeted for participation).
EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS
Number of
Number of Hours per Total burden
Form name responses per
respondents response hours
respondent
Environmental Scan Interviews ....................................................................... 50 1 2 100
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Document Created: 2016-02-10 00:19:09
Document Modified: 2016-02-10 00:19:09
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| Action | Notice of request for measures. | |
| Dates | Please submit one or more quality improvement measures and supporting information on or before March 4, 2016. AHRQ will not respond individually to submitters, but will consider all submitted measures and publicly report the results of the review of the submissions in aggregate. | |
| Contact | [email protected] or Cindy | |
| FR Citation | 81 FR 7116 |
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